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Cerebral edema in intracerebral hemorrhage: pathogenesis, natural history, and potential treatments from translation to clinical trials

Krishnan, Kailash; Campos, Paula Bermell; Nguyen, Thanh N.; Tan, Chia Wei; Chan, Siang Liang; Appleton, Jason P.; Law, ZheKang; Hollingworth, Milo; Kirkman, Matthew A.; England, Timothy J.; Roffe, Christine; Macleod, Mary Joan; Dawson, Jesse; Bayraktutan, Ulvi; Werring, David J.; Sprigg, Nikola; Bath, Philip M.

Authors

Kailash Krishnan

Paula Bermell Campos

Thanh N. Nguyen

Chia Wei Tan

Siang Liang Chan

Jason P. Appleton

ZheKang Law

Milo Hollingworth

Matthew A. Kirkman

Timothy J. England

Mary Joan Macleod

Jesse Dawson

Ulvi Bayraktutan

David J. Werring

Nikola Sprigg

Philip M. Bath



Abstract

Acute intracerebral hemorrhage is the most devastating stroke subtype and is associated with significant morbidity and mortality. Poor prognosis is associated with primary brain injury from the presenting hematoma, and despite advances in clinical trials of evacuation or reducing expansion, management is largely limited to supportive care and secondary prevention. Recent research has led to a better understanding of the pathophysiology of the cerebral edema surrounding the hematoma (perihematomal edema) and the identification of treatment targets and potential interventions. Some therapies have progressed to testing in phase 2 and 3 clinical trials, while novel agents are in development. This review focuses on the pathogenesis of perihematomal edema and its natural history and summarizes the results of potential interventions including preclinical and clinical studies. This review also lists the gaps in the current knowledge and suggests directions for future trials of perihematomal edema that could potentially change clinical practice.

Citation

Krishnan, K., Campos, P. B., Nguyen, T. N., Tan, C. W., Chan, S. L., Appleton, J. P., …Bath, P. M. (in press). Cerebral edema in intracerebral hemorrhage: pathogenesis, natural history, and potential treatments from translation to clinical trials. Frontiers in Stroke, 2, 1256664. https://doi.org/10.3389/fstro.2023.1256664

Journal Article Type Article
Acceptance Date Aug 28, 2023
Online Publication Date Sep 29, 2023
Deposit Date Oct 17, 2023
Journal Frontiers in Stroke
Publisher Frontiers Media
Peer Reviewed Peer Reviewed
Volume 2
Pages 1256664
DOI https://doi.org/10.3389/fstro.2023.1256664
Keywords intracerebral hemorrhage, pathophysiology, translation, cerebral edema, treatment, clinical trial


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