Hematoma expansion (HE) is a significant risk factor for poor prognosis in patients with intracerebral hemorrhage (ICH). Accurately predicting HE is crucial for determining optimal treatment strategies. This study enrolled 452 patients with ICH from 10 hospitals. To predict HE, 28 clinical variables available on patient arrival (including medical history, ICH location, and ICH volume) and 1142 radiomics features extracted from noncontrast computed tomography images of the ICH regions were used. Clinical variables and radiomics features were selected using gradient boosting and the least absolute shrinkage and selection operator. Three HE prediction models were built on clinical variables alone, radiomics features alone, and a third combining both. The models were compared using 5-fold cross-validation, and the mean area under the receiver operating characteristic curve was calculated for each. Additionally, the important features of HE prediction in the combined model were explored. The combined model demonstrated the highest performance for predicting HE with a 5-fold mean area under the receiver operating characteristic curve of 0.77±0.05, compared with 0.70±0.06 for the clinical variables alone and 0.73±0.04 for the radiomics features alone. Permutation feature importance analysis suggested that anticoagulant treatment was the most predictive of HE. A predictive model for HE was developed using the medical history, clinical features available on the patient's arrival, imaging, and radiomics features extracted from computed tomography images. This prediction model will assist non-stroke care specialists in making treatment decisions for ICH in emergency settings.

Pediatric intracerebral hemorrhage (pICH) is a rare but serious neurologic emergency associated with significant morbidity. Although pICH accounts for nearly half of all pediatric strokes, it remains understudied, and dedicated evidence-based management guidelines are lacking. To address this gap, the International Pediatric Stroke Organization convened a multidisciplinary international working group in 2020 to develop a comprehensive, consensus-based framework for the acute evaluation and management of pICH in children aged 28 days to 18 years. The working group included child neurologists, neurointensivists, neurosurgeons, neuroradiologists, and neurointerventionalists. Subgroups conducted systematic literature reviews and formulated key clinical questions. A modified Delphi process was used to derive consensus statements across 6 domains: prehospital and emergency care, diagnostic imaging and workup, neurocritical care and medical management, neurosurgical and neurointerventional approaches, and identification of knowledge gaps. Through rounds of structured review and voting, 21 consensus statements were developed and approved. The process was endorsed by multiple professional societies. This represents the first international, multidisciplinary, multisociety consensus statement focused on the acute management of pICH in children. It provides structured, expert-driven guidance to inform clinical decision-making, reduce practice variability, and highlight areas for future research. These consensus statements aim to support clinicians worldwide in improving outcomes for children with pICH.

Pediatric hemorrhagic stroke can lead to significant neurologic, cognitive, and behavioral morbidities that often emerge over time and can impede long-term academic, vocational, and socioemotional function. While many of the existing data stem from studies in arterial ischemic stroke, functional outcomes in hemorrhagic stroke, and particularly pediatric intracerebral hemorrhage, remain largely understudied. Extrapolating findings from ischemic stroke can be challenging, as there are notable differences in care and potentially in outcomes for hemorrhagic stroke. The primary goal of this consensus statement by a multidisciplinary group of stroke experts is to provide a review of the current literature on neurologic, cognitive, behavioral, and socioemotional outcomes after hemorrhagic stroke. Neurologically, children with pediatric intracerebral hemorrhage often experience motor deficits, including hemiparesis and coordination issues, as well as cognitive impairments affecting attention, memory, and executive function. Behavioral and emotional problems, such as depression, and social difficulties can also occur. Data on academic attainment are also presented, along with considerations regarding long-term outcomes and the transition to adulthood. We further examine a variety of key determinants predicting outcomes, including medical, demographic, familial, and socioeconomic factors, as well as current research on rehabilitation, with an emphasis on gold-standard guidelines for clinical interventions. Given the complexity of outcome measurement in pediatric hemorrhagic stroke and the lack of uniform tools for assessing outcomes across diverse populations, we propose guiding principles for outcome measurement, along with examples of domain-specific tools. Finally, we discuss the limitations of the current literature and outline goals for future clinical practice and research.

Decompressive craniectomy (DC) seemed to reduce the risk of death or profound disability (modified Rankin Scale score, 5-6) after deep intracerebral hemorrhage (ICH) by an absolute 13% (95% CI, 0%-26%) in the SWITCH trial (Swiss Trial of Decompressive Craniectomy versus Best Medical Treatment of Spontaneous Supratentorial Intracerebral Hemorrhage). Whether the effect of DC differs by ICH location is unknown. Post hoc analysis of participants with supratentorial severe deep ICH from the intention-to-treat population of the SWITCH randomized controlled trial. We categorized ICH as involving (1) the basal ganglia (BG) alone, (2) BG and the posterior limb of the internal capsule (PLIC), or (3) BG, PLIC, and thalamus. We examined the interaction between ICH location and DC's effect on primary (modified Rankin Scale score, 5-6) and secondary outcomes (death; full modified Rankin Scale score range) at 180 days using unadjusted and adjusted logistic or survival models. Of 197 participants comprising the trial's intention-to-treat population, 184 were available for analysis (median age, 61 years; 59 women; 91 randomized to DC plus best medical treatment; and 93 to best medical treatment). ICH involved BG alone in 26 (14%), BG+PLIC in 94 (51%), and BG+PLIC+thalamus in 64 participants (35%). The marginal risk of the primary outcome after adjustment for age, ICH severity, and volume was lower with DC by 15.6% (95% CI, -49.2% to 18.1%) in participants with ICH of BG alone, by 11.4% (-29.3% to 6.6%) in those with ICH of BG+PLIC, and by 9% (-31% to 12.9%) in those with ICH of BG+PLIC+thalamus, without evidence for treatment-by-location interaction (P=0.95). Secondary outcome analyses yielded consistent results. The potential benefits of DC seemed preserved regardless of the location of severe deep ICH. URL: https://www.clinicaltrials.gov; Unique identifier: NCT02258919.

Lipocalin-2 induces macrophage/microglia pro-inflammatory phenotype after intracerebral hemorrhage via Nrf2 signaling inhibition in young and aged mice.

Objectives Since andexanet alfa was approved in May 2022 in Japan, improvement in clinical outcomes of patients with intracranial hemorrhage while on factor Xa inhibitors (FXaIs) is expected. To assess real-world outcomes before approval, this study investigated the clinical outcomes in Japan prior to 2022. Methods Patients who developed intracerebral hemorrhage (ICH) or non-traumatic subarachnoid hemorrhage (SAH) and were admitted within 24 h of their last known well time or onset of symptoms between January 2016 and December 2021 were included. Data were obtained from the Japan Stroke Data Bank, a nationwide multicenter prospective registry. The outcomes were in-hospital mortality and favorable outcomes (modified Rankin Scale score of 0-2 at discharge). Results A total of 859 patients (rivaroxaban, n=227; apixaban, n=355; edoxaban, n=277) with ICH (ICH: n=822, age 79±9 years, 38.6% female; SAH: n=37, age 79±10, 75.7% female) were investigated. On admission, the median National Institutes of Health Stroke Scale (NIHSS) score in ICH patients was 13 [interquartile range (IQR): 6-24], and the median Glasgow Coma Scale score in patients with SAH was 11 [IQR: 6-14]. During the in-hospital period (20 [IQR: 11-37] days), 167 patients with ICH (20.3%) and 14 patients with SAH (37.8%) died in hospital; 135 patients with ICH (16.4%) and 5 patients with SAH (13.5%) achieved a favorable outcome. Conclusion This study presents the clinical outcomes prior to the approval of andexanet alfa. Further studies are needed to evaluate post-approval outcome changes.

Intracerebral hemorrhage (ICH) is one of the leading causes of death and disability worldwide, and the limited number of proven treatments is a critical area of medical concern. Although tremendous advances have been made in our knowledge of the patterns, risk factors, prognosis, management, and prevention, there has been limited success in defining therapeutic strategies and care remains fragmented and haphazard. The establishment of targeted, timely, and comprehensive management for patients with ICH is an urgent and critical priority. This consensus statement proposes an integrated ICH care pathway across stroke service levels, embedding ICH-specific protocols, time targets, and structured follow-up within existing stroke systems to ensure timely, evidence-based, and comprehensive management. The integrated ICH care pathway is designed to optimize ICH management across multiple dimensions, facilitate rapid decision-making and the initiation of treatments that span emergency medical services, emergency departments, and inpatient units, and extend through discharge and follow-up. The primary objective is to reduce delays and reinforce seamless collaboration between services to ensure all patients receive optimal care. By integrating evidence-based protocols for acute management, secondary prevention, rehabilitation, and follow-up, the integrated ICH care pathway aims to improve outcomes from ICH and foster a standardized multidisciplinary care framework with the goal of alleviating the clinical burden and socioeconomic impact of ICH.

WTAP-mediated N6-methyladenosine modification of UQCRQ promotes mitochondrial ROS and inflammatory response in microglia after intracerebral hemorrhage.

Multi-modal deep learning for predicting functional outcomes in intracerebral hemorrhage using 3D CT and clinical data.

Cerebral small vessel disease characteristics associate with domain-specific impairments during Intracerebral Hemorrhage: A retrospective cohort study.

Age-period-cohort analysis of stroke and subtype burdens from 1990 to 2021.

Double-virus infection method of lentivirus and adeno-associated virus was used to reveal the contribution of cerebellum in rehabilitative training after intracerebral hemorrhage (ICH) in rats. Chemogenetic blockade of cerebello-rubral pathway was achieved by the injection of a lentiviral vector pseudotyped with fusion glycoprotein type E and carrying Cre recombinase into the red nucleus and an adeno-associated viral vector encoding hM4D(Gi)-mCherry in the double-floxed, inverted orientation into the cerebellar lateral nucleus. This silencing system induced by clozapine-N-oxide significantly reduced the success rate of forelimb reaching test that is improved by forced-limb use after ICH. As a good application example of loss-of-function technique, the protocol of our experiment by double-virus infection method will be explained in detail.

Predictive value of maximum hemorrhage area and orthogonal diameter on non-contrast CT for assessing long-term unfavorable functional outcome in intracerebral hemorrhage

Innovative determination of time since injury in mice intracerebral hematomas through ATR-FTIR spectroscopy.

GPCRs in traumatic brain or spinal injury.

Risk factors for early poor outcomes in intracerebral hemorrhage with mild-to-moderate volume: A retrospective cohort study

The impact of first prescription of oral anticoagulation on ischemic stroke and major bleeding events among Medicare beneficiaries with atrial fibrillation (AF) is not known. A retrospective, observational, cohort study was performed based on a 5% sample of United States fee-for-service Medicare beneficiaries aged ≥66 years who developed AF from 2007 to 2020. The principal exposure was first prescription of an oral anticoagulant. The primary effectiveness end point was ischemic stroke (including cerebral or retinal ischemic stroke [central retinal artery occlusion]). The primary safety end point was major bleeding. To reduce the impact of selection bias and immortal time bias, unadjusted and adjusted hazard ratios (HRs) and rate differences were computed in a dataset comprised of pooled, sequential clinical trial replicates starting 1 month apart. In total, 144,969 patients (60.8% female; mean age 77.7 years [standard deviation (SD) 7.1]) were included in the study. First prescription of oral anticoagulation was not associated with a reduced hazard of ischemic stroke (adjusted HR [aHR] 1.01 [95% confidence interval (CI): 0.97-1.05]). However, first prescription of oral anticoagulation was associated with an increased hazard of a major bleeding event (aHR 1.38 [95% CI: 1.36-1.40]) and increased hazards of intracerebral hemorrhage (ICH) and major gastrointestinal hemorrhage. In this cohort study of Medicare beneficiaries aged 66 years and older with incident AF, the first anticoagulant prescription was not associated with a reduced hazard of ischemic stroke. Furthermore, unadjusted models suggested that clinicians are likely appropriately selecting patients for anticoagulation in routine clinical practice.

Oral microbiota dysbiosis contributes to occurrence of pneumonia in patients admitted to intensive care unit with spontaneous intracerebral hemorrhage.

Association between blood pressure and outcome in patients with acute ischemic stroke treated with alteplase.

Severity prediction in patients with oedema in cerebral contusion using deep learning from computed tomography scans.