Targeting secondary injury in intracerebral haemorrhage-perihaematomal oedema

Sebastian Urday, W. Taylor Kimberly, Lauren A. Beslow, Alexander O. Vortmeyer, Magdy H. Selim, Jonathan Rosand, J. Marc Simard, Kevin N. Sheth*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

136 Scopus citations

Abstract

Perihaematomal oedema (PHO) is an important pathophysiological marker of secondary injury in intracerebral haemorrhage (ICH). In this Review, we describe a novel method to conceptualize PHO formation within the framework of Starling's principle of movement of fluid across a capillary wall. We consider progression of PHO through three stages, characterized by ionic oedema (stage 1) and progressive vasogenic oedema (stages 2 and 3). In this context, possible modifiers of PHO volume and their value in identifying patients who would benefit from therapies that target secondary injury are discussed; the practicalities of using neuroimaging to measure PHO volume are also considered. We examine whether PHO can be used as a predictor of neurological outcome following ICH, and we provide an overview of emerging therapies. Our discussion emphasizes that PHO has clinical relevance both as a therapeutic target, owing to its augmentation of the mass effect of a haemorrhage, and as a surrogate marker for novel interventions that target secondary injury.

Original languageEnglish (US)
Pages (from-to)111-122
Number of pages12
JournalNature Reviews Neurology
Volume11
Issue number2
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

ASJC Scopus subject areas

  • Clinical Neurology
  • Cellular and Molecular Neuroscience

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