Intracerebral Hemorrhage: A Multimodality Approach to Improving Outcome

Excerpt

Intracerebral hemorrhage (ICH) is caused by a heterogeneous group of pathologies, but its injury upon cerebral tissue arises from similar mechanisms: direct cerebral tissue destruction, hematoma expansion, mass effect, inflammation, and toxicity associated with blood components and hemoglobin metabolic products such as iron [1‐8]. Primary ICH affects nearly four million individuals worldwide with 40 % of the patient unable to survive longer than 1 month [9]. Primary ICH is thought to arise from structural damage to perforating vessels leading to aneurysmal formation and subsequent rupture. Hypertension leads to degenerative changes within the vascular wall leading to vessel wall weakness and aneurysm formation while amyloid deposition within the vessel wall can lead to fibrinoid necrosis and thus subsequent vessel rupture. Most certainly, ideal treatment of any pathology lies in prevention, and thus managing hypertension is ideal in preventing ICH as well as recurrent episodes. …