Department of Neurology, Mayo Clinic, Phoenix, Arizona 85054, USA.
Semin Neurol. 2010 Nov;30(5):555-64. doi: 10.1055/s-0030-1268865. Epub 2011 Jan 4.
Spontaneous intracerebral hemorrhage (sICH) is defined as bleeding within the brain parenchyma, and occurs twice as commonly as subarachnoid hemorrhage, but is equally as deadly. Risk factors for sICH include hypertension, advanced age, leukoaraiosis, prior ICH, renal failure, use of anticoagulant drugs, and cerebral amyloid angiopathy. When a patient is clinically suspected of having sICH, head computed tomography scan is the standard diagnostic tool. However, newer magnetic resonance neuroimaging techniques may aid in determining the underlying pathology and aid in prognosis. Supportive care and blood pressure management are important in the care of patients with sICH. Ongoing research is aimed at determining a safe blood pressure goal that may also prevent expansion of hemorrhage. Hemostatic medications and neuroprotectants have thus far not shown clinical improvement. Although several neurosurgical trials have failed to demonstrate benefit for surgical evacuation of sICH, multiple research trials are ongoing investigating acute blood pressure control, deep or basal ganglionic hemorrhage evacuation via minimally invasive approach (MISTIE; http://mistietrial.com/default.aspx), lobar ICH evacuation (STICH; II http://research.ncl.ac.uk/stich/), and intraventricular thrombolysis with tissue plasminogen activator (tPA) (CLEAR III; http://biosgroup-johnshopkinsmedicine.health.officelive.com/default.aspx).
自发性脑出血（sICH）定义为脑实质内出血，其发生频率是蛛网膜下腔出血的两倍，但同样致命。sICH 的风险因素包括高血压、高龄、脑白质疏松症、既往脑出血、肾衰竭、抗凝药物的使用和脑淀粉样血管病。当临床怀疑患者患有 sICH 时，头部计算机断层扫描是标准的诊断工具。然而，更新的磁共振神经影像学技术可能有助于确定潜在的病理，并有助于预后判断。支持性护理和血压管理对于 sICH 患者的护理非常重要。目前正在进行的研究旨在确定一个安全的血压目标，这也可能防止出血扩大。止血药物和神经保护剂迄今为止并未显示出临床改善。尽管几项神经外科试验未能证明手术清除 sICH 有益，但多项研究试验正在进行中，以调查急性血压控制、通过微创途径（MISTIE；http://mistietrial.com/default.aspx）清除深部或基底节出血、脑叶出血清除（STICH；II http://research.ncl.ac.uk/stich/）和脑室内组织型纤溶酶原激活物（tPA）溶栓（CLEAR III；http://biosgroup-johnshopkinsmedicine.health.officelive.com/default.aspx）。
