Department of Neurology, University of Heidelberg, Heidelberg, Germany.
Stroke. 2010 Feb;41(2):402-9. doi: 10.1161/STROKEAHA.109.552919. Epub 2009 Dec 31.
Secondary expansion of hematoma after spontaneous intracerebral hemorrhage occurs frequently and early with the potential sequelae of functional deterioration or death. The aim of this topical review is to give a summary of current evidence- and experience-based options to avoid or attenuate hematoma expansion.
We reviewed the literature of the past 10 years on efforts to restrict spontaneous intracerebral hemorrhage expansion by searching Medline and adding related articles known to us. Based on evidence, current guidelines, and our own clinical practice, we have collected consistent and inconsistent pieces of data. These were differentiated according to surgical versus medical approaches, weighed and discussed with regard to expectable benefit, potential risk, and practicability. Finally, we have outlined promising future approaches.
Although consistent evidence on the topic is generally limited, some important studies have provided data on risk factors predicting spontaneous intracerebral hemorrhage expansion implying ways of directing therapy toward these risk factors. Large trials have shed light on 4 major efforts to avoid hematoma expansion: surgical hematoma treatment, reduction of hypertension, reversal of coagulopathies or anticoagulants, and hemostatic therapy. The results were largely disappointing but provide insights for new trials. Future strategies include the combination of surgical and medical treatment and the use of neuroprotectants.
Early restriction of intracerebral hemorrhage is of paramount importance because secondary volume expansion leads to outcome deterioration and death. Although there appear to be few indications for neurosurgical measures, nonsurgical measures such as reduction of hypertension and normalization of altered coagulation seem to be beneficial. However, the routine use of coagulation factors outside of warfarin-associated spontaneous intracerebral hemorrhage cannot generally be recommended at present. The same applies for future approaches such as combined medical-surgical approaches and neuroprotective therapies at this point.
自发性脑出血后血肿的二次扩张常发生较早，并可能导致功能恶化或死亡等后遗症。本文旨在综述目前基于证据和经验的各种选择，以避免或减轻血肿扩大。
我们通过检索 Medline 并加入我们已知的相关文章，对过去 10 年关于通过努力限制自发性脑出血扩大的文献进行了回顾。基于证据、当前指南和我们自己的临床实践，我们收集了一致和不一致的数据。这些数据根据手术与药物治疗方法进行了区分，并根据预期获益、潜在风险和可行性对其进行了权衡和讨论。最后，我们概述了有前途的未来方法。
尽管该主题的一致证据通常有限，但一些重要研究提供了预测自发性脑出血扩大的风险因素数据，暗示可以针对这些风险因素进行治疗。大型试验阐明了避免血肿扩大的 4 大主要努力：手术血肿治疗、降低高血压、逆转凝血异常或抗凝剂以及止血治疗。结果令人大失所望，但为新试验提供了一些思路。未来的策略包括手术和药物治疗的联合应用以及神经保护剂的使用。
早期限制颅内出血至关重要，因为继发性容量扩张会导致预后恶化和死亡。尽管神经外科措施的适应证似乎较少，但降低高血压和纠正异常凝血等非手术措施似乎有益。然而，目前一般不能推荐在华法林相关自发性脑出血之外常规使用凝血因子。在这一点上，对于未来的方法，如联合药物-手术方法和神经保护疗法，也是如此。
