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• W2912682028 abstract "Intracerebral hemorrhage (ICH) is the most devastating subtype of stroke and carries a high rate of disability and mortality. Substantial efforts need to be made to change the current critical situation and to elaborate effective treatments for acute ICH. After ICH occurs, secondary brain injury including early hematoma expansion (HE) and perihematomal edema (PHE) develops in most of the patients. HE has been regarded as one of the most important determinants of early neurological deterioration, mortality and poor clinical outcome in primary ICH. In contrast, the significance of PHE is still controversial. It is important to understand the development of these secondary brain injuries, and to elaborate predictive molecular or imaging factors that allow to identify patients at high risk of secondary brain injuries, and more important of poor clinical outcome. These patients would be most suitable for the evaluation of new treatments. We have shown that the presence of contrast extravasation on CT angiography (CTA) images in the hyperacute stage after ICH onset is a strong predictor of HE and poor clinical outcome, independent of the traditional factors such as hematoma volume and presence of intraventricular hemorrhage. The sign of contrast extravasation has been recommended as an entry criterion for future trials of hemostatic therapy in patients with acute ICH. PHE - the other type of secondary brain injury - immediately occurs in most of the patients after ICH. However, the chronology of PHE development and the clinical significance of PHE are still unclear. Our study demonstrates that PHE appears in all patients within the first 24 hours. At this time point PHE consists of vasogenic (VE) in all patients and cytotoxic edema (CE) in about half of the patients. PHE volume predominantly increases on day 1, but further increases during the first week after ICH. In patients with small to medium hematomas CE is pronounced on day 3 but tends to regress after 1 week. Of note, the temporal profile of CE is in line with the metabolic change in the perihematomal region and might be linked to ongoing neuronal injury. Furthermore, larger 3-day PHE volume and the presence of CE were associated with poor clinical outcome. Our findings show that PHE might play a role as important as hematoma size in small to medium ICH. In patients with small to medium hematoma volume, more therapeutic efforts should be made to prevent this type of secondary neuronal injury and thereby poor clinical outcome. Pathologically inflammation and their modulating markers play an important role in secondary brain injury and contribute to poor clinical outcome. Preclinical studies have demonstrated that matrix metalloproteinases (MMPs), a family of proteolytic enzymes, contribute to blood–brain barrier (BBB) disruption, neuronal injury, and brain edema after ICH. Asymmetric dimethylarginine (ADMA), a newly emerged mediator of oxidative and nitrosative stress, interacts with inflammation and might exacerbate the secondary brain injury. Our studies showed a significant association between MMP-3, MMP-9 and ADMA levels and their temporal pattern after acute ICH and clinical outcome. These data suggest these inflammatory markers and mediators as potential targets of ICH therapy at the molecular level." @default.
• W2912682028 created "2019-02-21" @default.
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• W2912682028 date "2012-01-01" @default.
• W2912682028 modified "2023-09-27" @default.
• W2912682028 title "Neuroradiological findings and molecular markers as predictors for secondary brain injury and outcome after intracerebral hemorrhage (ICH)" @default.
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