Elijovich Lucas, Patel Pratik V, Hemphill J Claude
Department of Neurology, University of California-San Francisco, San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110, USA.
Semin Neurol. 2008 Nov;28(5):657-67. doi: 10.1055/s-0028-1105974. Epub 2008 Dec 29.
Intracerebral hemorrhage (ICH) accounts for 10 to 15% of all strokes, but results in a disproportionately high morbidity and mortality. Although chronic hypertension accounts for the majority of ICH, other common causes include cerebral amyloid angiopathy, sympathomimetic drugs of abuse, and underlying cerebral vascular anomalies. Validated baseline predictors of clinical outcome after ICH include the Glasgow Coma Scale score, hematoma volume, presence and amount of intraventricular hemorrhage, infratentorial ICH location, and advanced age. Although no treatment of proven benefit currently exists for ICH, several recent large clinical trials have demonstrated the feasibility of surgical and medical treatments for ICH. Clinical research into ICH mechanisms of injury has demonstrated that hematoma expansion is common, even in patients without coagulopathy. Basic research has suggested that perihematoma injury is more likely related to toxicity of blood and iron in the brain ("neurohemoinflammation") rather than primary ischemic injury. Current guidelines for ICH treatment emphasize blood pressure management, urgent and rapid correction of coagulopathy, and surgery for cerebellar ICH. Ongoing clinical trials are investigating surgical evacuation of lobar hemorrhage, minimally invasive surgical hematoma evacuation, and aggressive blood pressure lowering.
脑出血（ICH）占所有中风病例的10%至15%，但其导致的发病率和死亡率却高得不成比例。虽然慢性高血压是脑出血的主要原因，但其他常见病因包括脑淀粉样血管病、滥用拟交感神经药物以及潜在的脑血管畸形。脑出血后临床结局的有效基线预测指标包括格拉斯哥昏迷量表评分、血肿体积、脑室内出血的存在及出血量、幕下脑出血部位以及高龄。虽然目前尚无经证实对脑出血有益的治疗方法，但最近的几项大型临床试验已证明了脑出血手术和药物治疗的可行性。对脑出血损伤机制的临床研究表明，即使在没有凝血功能障碍的患者中，血肿扩大也很常见。基础研究表明，血肿周围损伤更可能与脑中血液和铁的毒性（“神经血液炎症”）有关，而非原发性缺血性损伤。目前的脑出血治疗指南强调血压管理、紧急快速纠正凝血功能障碍以及小脑脑出血的手术治疗。正在进行的临床试验正在研究叶状出血的手术清除、微创外科血肿清除以及积极的血压降低。
