Gebel J M, Brott T G, Sila C A, Tomsick T A, Jauch E, Salisbury S, Khoury J, Miller R, Pancioli A, Duldner J E, Topol E J, Broderick J P
Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Stroke. 2000 Mar;31(3):596-600. doi: 10.1161/01.str.31.3.596.
Intracerebral hemorrhage (ICH) is a highly morbid disease process. Perihematomal edema is reported to contribute to clinical deterioration and death. Recent experimental observations indicate that clotting of the intrahematomal blood is the essential prerequisite for hyperacute perihematomal edema formation rather than blood-brain barrier disruption.
We compared a series of patients with spontaneous ICH (SICH) to a series of patients with thrombolysis-related ICH (TICH). All patients were imaged within 3 hours of clinical onset. We reviewed relevant neuroimaging features, emphasizing and quantifying perihematomal edema. We then analyzed clinical and radiological differences between the 2 ICH types and determined whether these factors were associated with perihematomal edema.
TICHs contained visible perihematomal edema less than half as often as SICHs (31% versus 69%, P<0.001) and had both lower absolute edema volumes (0 cc [25th, 75th percentiles: 0, 6] versus 6 cc [0, 13], P<0.0001) and relative edema volumes (0.16 [0.10, 0.33] versus 0.55 [0.40, 0.83], P<0.0001). Compared with SICHs, TICHs were 3 times larger in volume (median [25th, 75th percentiles] volume 69 cc [30, 106] versus 21 cc [8, 45], P<0.0001), 4 times more frequently lobar in location (62% versus 15%, P<0.001), 80 times more frequently contained blood-fluid level(s) (86% versus 1%, P<0.001), and were more frequently multifocal (22% versus 0%, P<0.001).
The striking qualitative and quantitative lack of perihematomal edema observed in the thrombolysis-related ICHs compared with the SICHs provides the first substantial, although indirect, human evidence that intrahematomal blood clotting is a plausible pathogenetic factor in hyperacute perihematomal edema formation.
脑出血（ICH）是一种高致残性疾病过程。据报道，血肿周围水肿会导致临床病情恶化和死亡。最近的实验观察表明，血肿内血液凝固是超急性血肿周围水肿形成的必要前提，而非血脑屏障破坏。
我们将一系列自发性脑出血（SICH）患者与一系列溶栓相关脑出血（TICH）患者进行了比较。所有患者均在临床发病后3小时内进行了成像检查。我们回顾了相关的神经影像学特征，重点关注并量化了血肿周围水肿。然后，我们分析了这两种脑出血类型之间的临床和影像学差异，并确定这些因素是否与血肿周围水肿相关。
TICH患者出现可见血肿周围水肿的频率不到SICH患者的一半（31%对69%，P<0.001），绝对水肿体积较低（0 cc [第25、75百分位数：0，6]对6 cc [0，13]，P<0.0001），相对水肿体积也较低（0.16 [0.10，0.33]对0.55 [0.40，0.83]，P<0.0001）。与SICH相比，TICH的体积大3倍（中位数[第25、75百分位数]体积69 cc [30，106]对21 cc [8，45]，P<0.0001），位于脑叶的频率高4倍（62%对15%，P<0.001），含有血液-液平面的频率高80倍（86%对1%，P<0.001），且多灶性更常见（22%对0%，P<0.001）。
与SICH相比，溶栓相关脑出血中血肿周围水肿在定性和定量方面的显著缺乏，首次提供了实质性的（尽管是间接的）人体证据，表明血肿内血液凝固是超急性血肿周围水肿形成中一个合理的致病因素。
