Predictors of hematoma expansion predictors after intracerebral hemorrhage

// Sheng Chen 1,* , Binjie Zhao 1,* , Wei Wang 1,* , Ligen Shi 1 , Cesar Reis 2,3 and Jianmin Zhang 1 1 Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, PR China 2 Department of Physiology and Pharmacology, Loma Linda University, Loma Linda, California, USA 3 Department of Preventive Medicine, Loma Linda University, Loma Linda, California, USA * The first three authors have contributed equally to the work Correspondence to: Jianmin Zhang, email: // or zjm135@zju.edu.cn Keywords : intracerebral hemorrhage, hematoma expansion, predictor Received : March 24, 2017 Accepted : June 19, 2017 Published : July 18, 2017 Abstract Despite years of effort, intracerebral hemorrhage (ICH) remains the most devastating form of stroke with more than 40% 30-day mortality worldwide. Hematoma expansion (HE), which occurs in one third of ICH patients, is strongly predictive of worse prognosis and potentially preventable if high-risk patients were identified in the early phase of ICH. In this review, we summarize data from recent studies on HE prediction and classify those potential indicators into four categories: clinical (severity of consciousness disturbance; blood pressure; blood glucose at and after admission); laboratory (hematologic parameters of coagulation, inflammation and microvascular integrity status), radiographic (interval time from ICH onset; baseline volume, shape and density of hematoma; intraventricular hemorrhage; especially the spot sign and modified spot sign) and integrated predictors (9-point or 24-point clinical prediction algorithm and PREDICT A/B). We discuss those predictors’ underlying pathophysiology in HE and present opportunities to develop future therapeutic strategies.