Hematoma Expansion in Intracerebral Hemorrhage: An Update on Prediction and Treatment

Abstract

Intracerebral hemorrhage (ICH) is the most lethal type of stroke, but there is no specific treatment. After years of effort, neurologists have found that hematoma expansion (HE) is a vital predictor of poor prognosis in ICH patients, with a not uncommon incidence ranging widely from 13 to 38%. Herein, the progress of studies on HE after ICH in recent years is updated, and the topics of definition, prevalence, risk factors, prediction score models, mechanisms, treatment, and prospects of HE are covered in this review. The risk factors and prediction score models, including clinical, imaging, and laboratory characteristics, are elaborated in detail, but limited by sensitivity, specificity, and inconvenience to clinical practice. The management of HE is also discussed from bench work to bed practice. However, the upmost problem at present is that there is no treatment for HE proven to definitely improve clinical outcomes. Further studies are needed to identify more accurate predictors and effective treatment to reduce HE.

Keywords: hematoma expansion; intracerebral hemorrhage; prediction score model; risk factor; treatment.

Figure 1

Representative examples of NCCT markers of HE. (A) Blend sign refers to the blending of hyperattenuating region with adjacent relatively hypoattenuating area with a well-defined margin. (B) Black hole sign refers to the round, oval, or rod-shaped relatively hypoattenuated area inside the hyperattenuated hematoma with a clear border to nearby brain tissue. (C) Island sign refers to three or more scattered small hematoma detached from the main hematoma, or more than 4 small hematoma connected partly or wholly with the main hematoma. (D) Satellite sign refers to the high-density dots around the hematoma.