Treatment of Edema Associated With Intracerebral Hemorrhage

  • Audrey Leasure
  • W. Taylor Kimberly
  • Lauren H. Sansing
  • Kristopher T. Kahle
  • Golo Kronenberg
  • Hagen Kunte
  • J. Marc Simard
  • Kevin N. Sheth
Critical Care Neurology (K Sheth, Section Editor)

DOI: 10.1007/s11940-015-0392-z

Cite this article as:
Leasure, A., Kimberly, W.T., Sansing, L.H. et al. Curr Treat Options Neurol (2016) 18: 9. doi:10.1007/s11940-015-0392-z
Part of the following topical collections:
  1. Topical Collection on Critical Care Neurology

Opinion statement

Cerebral edema (i.e., “brain swelling”) is a common complication following intracerebral hemorrhage (ICH) and is associated with worse clinical outcomes. Perihematomal edema (PHE) accumulates during the first 72 h after hemorrhage, and during this period, patients are at risk of clinical deterioration due to the resulting tissue shifts and brain herniation. First-line medical therapies for patients symptomatic of PHE include osmotic agents, such as mannitol in low- or high-dose bolus form, or boluses of hypertonic saline (HTS) at varied concentrations with or without subsequent continuous infusion. Decompressive craniectomy may be required for symptomatic edema refractory to osmotherapy. Other strategies that reduce PHE such as hypothermia and minimally invasive surgery have shown promise in pilot studies and are currently being evaluated in larger clinical trials. Ongoing basic, translational, and clinical research seek to better elucidate the pathophysiology of PHE to identify novel strategies to prevent edema formation as a next major advance in the treatment of ICH.

Keywords

Intracerebral hemorrhage Perihematomal edema Secondary brain injury Hyperosmolar therapy ICP 

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Audrey Leasure
    • 1
  • W. Taylor Kimberly
    • 2
  • Lauren H. Sansing
    • 1
  • Kristopher T. Kahle
    • 3
  • Golo Kronenberg
    • 4
  • Hagen Kunte
    • 4
  • J. Marc Simard
    • 5
  • Kevin N. Sheth
    • 1
  1. 1.Department of NeurologyYale University School of MedicineNew HavenUSA
  2. 2.Department of NeurologyMassachusetts General HospitalBostonUSA
  3. 3.Yale Program on Neurogenetics, Department of Neurosurgery and PediatricsNew HavenUSA
  4. 4.Department of NeurologyCharité-Universitätsmedizin BerlinBerlinGermany
  5. 5.Department of NeurosurgeryUniversity of Maryland School of MedicineBaltimoreUSA