Department of Neurology, University of Minnesota, MMC 295, 420 Delaware Street S.E., Minneapolis, MN, 55455, USA.
Department of Neurology, San Camillo de' Lellis District General Hospital, Rieti, Italy.
Neurocrit Care. 2019 Aug;31(1):188-195. doi: 10.1007/s12028-018-0564-2.
Spontaneous intracerebral hemorrhage (ICH) is a devastating form of stroke, with a high rate of mortality and morbidity. Even with the best current medical or surgical interventions, outcomes remain poor. The location and initial hematoma volume are strong predictors of mortality. Hematoma expansion (HE) is a further marker of poor prognosis that may be at least partly preventable. Several risk factors for HE have been identified, including baseline ICH volume, anticoagulation, and computed tomography angiography spot signs. Recent studies have shown the correlation of serum calcium (Ca) levels on admission with HE. Low serum Ca level has been associated with larger hematoma volume at the time of presentation, HE, and worse outcome. Although the causal and mechanistic links between low serum Ca level and HE are not well understood, several mechanisms have been proposed including coagulopathy, platelet dysfunction, and higher blood pressure (BP) in the context of low serum Ca level. However, low serum Ca level might be only a biomarker of the adaptive response due to acute inflammatory response following acute ICH. The purpose of the current review is to discuss the evidence regarding the possible role of low serum Ca level on HE in acute ICH.
自发性脑出血 (ICH) 是一种具有高死亡率和发病率的毁灭性中风形式。即使采用目前最好的医疗或手术干预措施，结果仍然不佳。血肿位置和初始血肿量是死亡率的强预测因子。血肿扩大 (HE) 是预后不良的进一步标志物，至少在一定程度上是可以预防的。已经确定了 HE 的几个危险因素，包括基线 ICH 体积、抗凝和计算机断层血管造影点征。最近的研究表明，入院时血清钙 (Ca) 水平与 HE 相关。低血清 Ca 水平与发病时更大的血肿体积、HE 和更差的预后相关。尽管低血清 Ca 水平与 HE 之间的因果和机制联系尚未完全清楚，但已经提出了几种机制，包括凝血障碍、血小板功能障碍以及低血清 Ca 水平下的更高血压 (BP)。然而，低血清 Ca 水平可能只是由于急性 ICH 后急性炎症反应引起的适应性反应的生物标志物。本综述的目的是讨论低血清 Ca 水平对急性 ICH 中 HE 的可能作用的证据。
