Department of Neurology, University of New Mexico, Albuquerque, NM, USA.
Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
J Stroke Cerebrovasc Dis. 2022 Jul;31(7):106489. doi: 10.1016/j.jstrokecerebrovasdis.2022.106489. Epub 2022 Apr 27.
Intracerebral hemorrhage (ICH) is a devastating subtype of stroke associated with high morbidity and mortality that is considered a medical emergency, mainly managed with adequate blood pressure control and creating a favorable hemostatic condition. However, to date, none of the randomized clinical trials have led to an effective treatment for ICH. It is vital to better understand the mechanisms underlying brain injury to effectively decrease ICH-associated morbidity and mortality. It is well known that initial hematoma formation and its expansion have detrimental consequences. The literature has recently focused on other pathological processes, including oxidative stress, neuroinflammation, blood-brain barrier disruption, edema formation, and neurotoxicity, that constitute secondary brain injury. Since conventional management has failed to improve clinical outcomes significantly, various neuroprotective therapies are tested in preclinical and clinical settings. Unlike intravenous administration, intranasal insulin can reach a higher concentration in the cerebrospinal fluid without causing systemic side effects. Intranasal insulin delivery has been introduced as a novel neuroprotective agent for certain neurological diseases, including ischemic stroke, subarachnoid hemorrhage, and traumatic brain injury. Since there is an overlap of mechanisms causing neuroinflammation in these neurological diseases and ICH, we believe that preclinical studies testing the role of intranasal insulin therapy in ICH are warranted.
脑出血（ICH）是一种严重的中风亚型，其发病率和死亡率较高，被认为是一种医疗急救，主要通过适当控制血压和创造有利的止血条件来治疗。然而，迄今为止，没有一项随机临床试验能为 ICH 提供有效的治疗方法。更好地了解脑损伤的机制对于有效降低 ICH 相关发病率和死亡率至关重要。众所周知，初始血肿形成及其扩展会产生有害的后果。最近，文献的重点放在了其他病理过程上，包括氧化应激、神经炎症、血脑屏障破坏、水肿形成和神经毒性，这些都构成了继发性脑损伤。由于常规治疗未能显著改善临床结局，因此在临床前和临床环境中测试了各种神经保护疗法。与静脉内给药不同，鼻内胰岛素可以在不引起全身副作用的情况下在脑脊液中达到更高的浓度。鼻内胰岛素给药已被引入作为某些神经疾病的新型神经保护剂，包括缺血性中风、蛛网膜下腔出血和创伤性脑损伤。由于这些神经疾病和 ICH 引起神经炎症的机制有重叠，我们认为有必要进行临床前研究，以测试鼻内胰岛素治疗在 ICH 中的作用。
