Intracerebral Hemorrhage: Perihemorrhagic Edema and Secondary Hematoma Expansion: From Bench Work to Ongoing Controversies

Area of Science:

• Neurology
• Neurosurgery
• Neuroscience

Background:

• Intracerebral hemorrhage (ICH) is a critical neurological emergency with high mortality and disability rates.
• Poor outcomes in ICH are attributed to primary structural damage and secondary injury mechanisms.
• Secondary injury involves hematoma expansion (HE) and perihemorrhagic edema (PHE), contributing to neuroinflammation and neuronal death.

Approach:

• This review synthesizes findings from animal studies, human observational studies, and clinical trials.
• It specifically focuses on the pathophysiological mechanisms of PHE and HE in the context of ICH.
• The review examines the continuum of neuroinflammation, neuronal death, and edema formation post-ICH.

Key Points:

• Perihemorrhagic edema (PHE) is a significant contributor to secondary brain injury after ICH.
• Hematoma expansion (HE) exacerbates primary damage and influences secondary injury progression.
• Understanding these mechanisms is crucial for developing targeted therapies for ICH patients.

Conclusions:

• Secondary injury, particularly PHE and HE, plays a critical role in the poor outcomes associated with intracerebral hemorrhage.
• Further research into these mechanisms, supported by diverse study types, is essential for improving clinical management of ICH.
• This review provides a comprehensive overview of current knowledge on PHE and HE in ICH, highlighting areas for future investigation.