Intracerebral hematoma expansion
Making predictions (about the future)
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Intracerebral hemorrhage (ICH) can be due to diverse causes and is the least treatable form of stroke. Over a decade ago, Brott and colleagues1 noted that growth of cerebral hematoma volume occurs in 38% of patients who are initially imaged using a CT scan within 3 hours of stroke onset and then imaged again within 24 hours of stroke onset. Hematoma expansion (HE) subsequently attracted interest as a potential therapeutic target.
If acute ischemic strokes can be treated with “clot busters,” then perhaps acute ICH could be treated with “clot promoters.” Trials of hemostatic agents and acute blood pressure lowering have been conducted in recent years.2,3 Although each approach has succeeded in reducing HE, neither has yet shown definite benefit on patient outcome (with fully powered studies of blood pressure lowering still in progress).
An important issue from the clinical and research trial standpoint is whether HE remains a reasonable therapeutic target. One possible explanation for the failure to translate reduced HE into improved outcome is inconsistent definition of clinically important …
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