Skip to main content
SpringerLink
Log in

Intracerebral hemorrhage

Pathophysiology and therapy

  • Review Article
  • Published:
Neurocritical Care Aims and scope Submit manuscript

Abstract

Spontaneous intracerebral hemorrhage, from several sources, causes instantaneous mass effect, disruption of surrounding brain, and often an early neurological death. If the patient survives the initial event, the hematoma can lead to secondary brain injury, neurological deficits, and, occasionally, delayed fatality. The mechanisms that trigger pathophysiological changes in and around the hematoma are becoming better understood, offering new therapeutic opportunities.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kase CS, Caplan LR. Intracerebral Hemorrhage. In: Kase CS, Caplan LR, eds. Boston: Butterworth-Heinemann, 1994.

    Google Scholar 

  2. Spatz H. Patologische anatomie der kreislaufstorungen des gehirns. Zeitschrift fur Neurologie 1939;167:301–351.

    Google Scholar 

  3. McKissock W, Richardson A, Walsh L. Primary intracerebral haemorrhage: results of surgical treatment in 244 consecutive cases. Lancet 1959;1:683.

    Article  Google Scholar 

  4. McKissock W, Richardson A, Taylor J. Primary intracerebral haemorrhage: a controlled trial of surgical and conservative treatment in 180 unselected cases. Lancet 1961;2:221–226.

    Article  Google Scholar 

  5. Ojemann RG, Mohr JP. Hypertensive brain hemorrhage. Clin Neurosurg 1976;23:220–244.

    PubMed  CAS  Google Scholar 

  6. Broderick JP, Brott TG, Tomsick T, Barsan W, Spilker J. Ultra-early evaluation of intracerebral hemorrhage. J Neurosurg 1990;72:195–199.

    PubMed  CAS  Google Scholar 

  7. Fujii Y, Tanaka R, Takeuchi S, Koike T, Minakawa T, Sasaki O. Hematoma enlargement in spontaneous intracerebral hemorrhage. J Neurosurg 1994;80:51–57.

    PubMed  CAS  Google Scholar 

  8. Fujii Y, Takeuchi S, Sasaki O, Minakawa T, Tanaka R. Multivariate analysis of predictors of hematoma enlargement in spontaneous intracerebral hemorrhage. Stroke 1998;29:1160–1166.

    PubMed  CAS  Google Scholar 

  9. Kazui S, Naritomi H, Yamamoto H, Sawada T, Yamaguchi T. Enlargement of spontaneous intracerebral hemorrhage. Incidence and time course. Stroke 1996;27:1783–1787.

    PubMed  CAS  Google Scholar 

  10. Brott T, Broderick J, Kothari R, et al. Early hemorrhage growth in patients with intracerebral hemorrhage. Stroke 1997;28:1–5.

    PubMed  CAS  Google Scholar 

  11. Kazui S, Minematsu K, Yamamoto H, Sawada T, Yamaguchi T. Predisposing factors to enlargement of spontaneous intracerebral hematoma. Stroke 1997;28:2370–2375.

    PubMed  CAS  Google Scholar 

  12. Zazulia AR, Diringer MN, Derdeyn CP, Powers WJ. Progression of mass effect after intracerebral hemorrhage. Stroke 1999;30:1167–1173.

    PubMed  CAS  Google Scholar 

  13. Mayer SA. Ultra-early hemostatic therapy for intracerebral hemorrhage. Stroke 2003;34:224–229.

    Article  PubMed  Google Scholar 

  14. Hayman LA, Pagani JJ, Kirkpatrick JB, Hinck VC. Pathophysiology of acute intracerebral and subarachnoid hemorrhage: applications to MR imaging. Am J Roentgenol 1989;153:135–139.

    CAS  Google Scholar 

  15. Gomori JM, Grossman RI, Goldberg HI, Zimmerman RA, Bilaniuk LT. Intracranial hematomas: imaging by high-field MR. Radiology 1985;157:87–93.

    PubMed  CAS  Google Scholar 

  16. Mutlu N, Berry RG, Alpers BJ. Massive cerebral hemorrhages. Clinical and pathological correlation. Arch Neurol 1963;8:644–661.

    PubMed  CAS  Google Scholar 

  17. Garcia JH, Ho KL, Caccamo D. Intracerebral hemorrhage: Pathology of selected topics. In: Kase CS, Caplan LR, eds. Intracerebral Hemorrhage. Boston: Butterworth-Heinemann, 1994, pp. 45–72.

    Google Scholar 

  18. Dul K, Drayer BP. CT and MR imaging of intracerebral hemorrhage. In: Kase CS, Caplan LR, eds. Intracerebral Hemorrhage. Boston: Butterworth-Heinemann, 1994, pp. 73–98.

    Google Scholar 

  19. Wagner KR, Xi G, Hua Y, et al. Lobar intracerebral hemorrhage model in pigs: rapid edema development in perihematomal white matter. Stroke 1996;27:490–497.

    PubMed  CAS  Google Scholar 

  20. Xi G, Reiser G, Keep RF. The role of thrombin and thrombin receptors in ischemic, hemorrhagic and traumatic brain injury: deleterious or protective? J Neurochem 2003;84:3–9.

    Article  PubMed  CAS  Google Scholar 

  21. Lee KR, Colon GP, Betz AL, Keep RF, Kim S, Hoff JT. Edema from intracerebral hemorrhage: the role of thrombin. J Neurosurg 1996;84:91–96.

    Article  PubMed  CAS  Google Scholar 

  22. Xi G, Wagner KR, Keep RF, et al. The role of blood clot formation on early edema development following experimental intracerebral hemorrhage. Stroke 1998;29:2580–2586.

    PubMed  CAS  Google Scholar 

  23. Hua Y, Schallert T, Keep RF, Wu J, Hoff JT, Xi G. Behavioral tests after intracerebral hemorrhage in the rat. Stroke 2002;33:2478–2484.

    Article  PubMed  Google Scholar 

  24. Hamada R, Matsuoka H, Wagner KR, et al. Antithrombin therapy for intracerebral hemorrhage. Stroke 2000;31:794–795.

    PubMed  CAS  Google Scholar 

  25. Hua Y, Xi G, Keep RF, Hoff JT. Complement activation in the brain after experimental intracerebral hemorrhage. J Neurosurg 2000;92:1016–1022.

    PubMed  CAS  Google Scholar 

  26. Xi G, Hua Y, Keep RF, Younger JG, Hoff JT. Systemic complement depletion diminishes perihematomal brain edema. Stroke 2001;32:162–167.

    PubMed  CAS  Google Scholar 

  27. Bradley WG, Jr. MR appearance of hemorrhage in the brain. Radiology 1993;189:15–26.

    PubMed  Google Scholar 

  28. Xi G, Keep RF, Hoff JT. Erythrocytes and delayed brain edema formation following intracerebral hemorrhage in rats. J Neurosurg 1998;89:991–996.

    PubMed  CAS  Google Scholar 

  29. Enzmann DR, Britt RH, Lyons BE, Buxton JL, Wilson DA. Natural history of experimental intracerebral hemorrhage: sonography, computed tomography and neuropathology. Am J Neuroradiol 1981;2:517–526.

    PubMed  CAS  Google Scholar 

  30. Darrow VC, Alvord EC, Jr., Mack LA, Hodson WA. Histologic evolution of the reactions to hemorrhage in the premature human infant’s brain. A combined ultrasound and autopsy study and a comparison with the reaction in adults. Am J Pathol 1988;130:44–58.

    PubMed  CAS  Google Scholar 

  31. Marlet JM, Barreto Fonseca JDP. Experimental determination of time of intracranial hemorrhage by spectrophotometric analysis of cerebrospinal fluid. J Forensic Sci 1982;27:880–888.

    PubMed  CAS  Google Scholar 

  32. Wahlgren NG, Lindquist C. Haem derivatives in the cerebrospinal fluid after intracranial haemorrhage. Eur Neurol 1987;26:216–221.

    PubMed  CAS  Google Scholar 

  33. Koeppen AH, Dickson AC, McEvoy JA. The cellular reactions to experimental intracerebral hemorrhage. J Neurol Sci 1995;134:102–112.

    Article  PubMed  Google Scholar 

  34. Park CC, Shin ML, Simard JM. The complement membrane attack complex and the bystander effect in cerebral vasospasm. J Neurosurg 1997;87:294–300.

    PubMed  CAS  Google Scholar 

  35. Strassmann G. Hemosiderin and tissue iron in the brain, its relationship and importance. J Neuropathol Exp Neurol 1945;4:393–401.

    CAS  Google Scholar 

  36. Strassmann G. Formation of hemosiderin and hematoidin after traumatic and spontaneous cerebral hemorrhages. Arch Pathol 1949;47:205–210.

    CAS  Google Scholar 

  37. Huang F, Xi G, Keep RF, Hua Y, Nemoianu A, Hoff JT. Brain edema after experimental intracerebral hemorrhage: role of hemoglobin degradation products. J Neurosurg 2002;96:287–293.

    PubMed  Google Scholar 

  38. Peeling J, Yan HJ, Chen SG, Campbell M, Del Bigio MR. Protective effects of free radical inhibitors in intracerebral hemorrhage in rat. Brain Res 1998;795:63–70.

    Article  PubMed  CAS  Google Scholar 

  39. Peeling J, Del Bigio MR, Corbett D, Green AR, Jackson DM. Efficacy of disodium 4-[(tertbutylimino)methyl]benzene-1,3-disulfonate N-oxide (NXY-059), a free radical trapping agent, in a rat model of hemorrhagic stroke. Neuropharmacology 2001;40:433–439.

    Article  PubMed  CAS  Google Scholar 

  40. Hall NC, Packard BA, Hall CL, de Courten-Myers G, Wagner KR. Protein oxidation and enzyme susceptibility in white and gray matter with in vitro oxidative stress: relevance to brain injury from intracerebral hemorrhage. Cell Molec Biol 2000;46:673–683.

    CAS  Google Scholar 

  41. Wu J, Hua Y, Keep RF, Schallert T, Hoff JT, Xi G. Oxidative brain injury from extravasated erythrocytes after intracerebral hemorrhage. Brain Res 2002;953:45–52.

    Article  PubMed  CAS  Google Scholar 

  42. Suzuki J, Ebina T. Sequential changes in tissue surrounding ICH. In: Pia HW, Longmaid C, Zierski J, eds. Spontaneous Intracerebral Hematomas. Berlin: Springer, 1980, pp. 121–128.

    Google Scholar 

  43. Ropper AH. Lateral displacement of the brain and level of consciousness in patients with an acute hemispheral mass. N Eng J Med 1986;314:953–958.

    Article  CAS  Google Scholar 

  44. Tomita H, Ito U, Ohno K, Hirakawa K. Chronological changes in brain edema induced by experimental intracerebral hematoma in cats. Acta Neurochir 1994;60(Suppl):558–560.

    CAS  Google Scholar 

  45. Yang GY, Betz AL, Chenevert TL, Brunberg JA, Hoff JT. Experimental intracerebral hemorrhage: relationship between brain edema, blood flow, and blood-brain barrier permeability in rats. J Neurosurg 1994;81:93–102.

    PubMed  CAS  Google Scholar 

  46. Jenkins A, Maxwell W, Graham D. Experimental intracerebral hematoma in the rat: sequential light microscopic changes. Neuropathol Appl Neurobiol 1989;15:477–486.

    Article  PubMed  CAS  Google Scholar 

  47. Broderick J, Brott T, Kothari R. Very early edema growth with ICH. Stroke 1995;26:184.

    Google Scholar 

  48. Suzuki R, Ohno K, Hiratsuka H, Inaba Y. Chronological changes in brain edema in hypertensive intracerebral hemorrhage observed by CT and xenon-enhanced CT. In Inaba Y, Klatzo I, Spatz M, eds. Brain Edema. Berlin: Springer, 1985, pp. 613–620.

    Google Scholar 

  49. Ropper AH, King RB. Intracranial pressure monitoring in comatose patients with cerebral hemorrhage. Arch Neurol 1984;41:725–728.

    PubMed  CAS  Google Scholar 

  50. Lee KR, Betz AL, Kim S, Keep RF, Hoff JT. The role of the coagulation cascade in brain edema formation after intracerebral hemorrhage. Acta Neurochir 1996;138:396–400.

    Article  CAS  Google Scholar 

  51. Mendelow AD. Mechanisms of ischemic brain damage with intracerebral hemorrhage. Stroke 1993;24:1115–1117.

    Google Scholar 

  52. Mayer SA, Lignelli A, Fink ME, et al. Perilesional blood flow and edema formation in acute intracerebral hemorrhage: a SPECT study. Stroke 1998;29:1791–1798.

    PubMed  CAS  Google Scholar 

  53. Gebel JM, Brott TG, Sila CA, et al. Decreased perihematomal edema in thrombolysis-related intracerebral hemorrhage compared with spontaneous intracerebral hemorrhage. Stroke 2000;31:596–600.

    PubMed  CAS  Google Scholar 

  54. Gebel JM, Sila CA, Sloan MA, et al. Thrombolysis-related intracranial hemorrhage: a radiographic analysis of 244 cases from the GUSTO-1 trial with clinical correlation. Global utilization of streptokinase and tissue plasminogen activator for occluded coronary arteries. Stroke 1998;29:563–569.

    PubMed  CAS  Google Scholar 

  55. Xi G, Keep RF, Hoff JT. Pathophysiology of brain edema formation. Neurosurg Clin N Am 2002;13:371–383.

    Article  PubMed  Google Scholar 

  56. Lee KR, Betz AL, Keep RF, Chenevert TL, Kim S, Hoff JT. Intracerebral infusion of thrombin as a cause of brain edema. J Neurosurg 1995;83:1045–1050.

    Article  PubMed  CAS  Google Scholar 

  57. Mun-Bryce S, Kroh FO, White J, Rosenberg GA. Brain lactate and pH dissociation in edema: 1H- and 31P-NMR in collagenase-induced hemorrhage in rats. Am J Physiol 1993;265:R697-R702.

    PubMed  CAS  Google Scholar 

  58. Betz AL, Iannotti F, Hoff JT. Brain edema: a classification based on blood-brain barrier integrity. Cereb Brain Metab Rev 1989;1:133–154.

    CAS  Google Scholar 

  59. Lee KR, Kawai N, Kim S, Sagher O, Hoff JT. Mechanisms of edema formation after intracerebral hemorrhage: effects of thrombin on cerebral blood flow, blood-brain barrier permeability, and cell survival in a rat model. J Neurosurg 1997;86:272–278.

    PubMed  CAS  Google Scholar 

  60. Rosenberg GA, Navratil M. Metalloproteinase inhibition blocks edema in intracerebral hemorrhage in the rat. Neurology 1997;48:921–926.

    PubMed  CAS  Google Scholar 

  61. Masuda T, Dohrmann GJ, Kwaan HC, Erickson RK, Wollman RL. Fibrinolytic activity in experimental intracerebral hematoma. J Neurosurg 1988;68:274–278.

    PubMed  CAS  Google Scholar 

  62. Zulch KH. Hemorrhage, thrombosis, embolism. In: Minckler J, ed. Pathology of the Nervous System. New York: McGraw-Hill, 1971, pp. 1499–1535.

    Google Scholar 

  63. Hickenbottom SL, Grotta JC, Strong R, Denner LA, Aronowski J. Nuclear factor-kappa B and cell death after experimental intracerebral hemorrhage in rats. Stroke 1999;30:2472–2477.

    PubMed  CAS  Google Scholar 

  64. Matsushita K, Meng W, Wang X, et al. Evidence for apoptosis after intercerebral hemorrhage in rat striatum. J Cereb Blood Flow Metab 2000;20:396–404.

    Article  PubMed  CAS  Google Scholar 

  65. Xue M, Del Bigio MR. Intracerebral injection of autologous whole blood in rats: time course of inflammation and cell death. Neurosci Lett 2000;283:230–232.

    Article  PubMed  CAS  Google Scholar 

  66. Gong C, Boulis N, Qian J, Turner DE, Hoff JT, Keep RF. Intracerebral hemorrhage-induced neuronal death. Neurosurgery 2001;48:875–883.

    Article  PubMed  CAS  Google Scholar 

  67. Qureshi AI, Ling GS, Khan J, et al. Quantitative analysis of injured, necrotic, and apoptotic cells in a new experimental model of intracerebral hemorrhage. Crit Care Med 2001;29:152–157.

    Article  PubMed  CAS  Google Scholar 

  68. Felberg RA, Grotta JC, Shirzadi AL, et al. Cell death in experimental intracerebral hemorrhage: the “black hole” model of hemorrhagic damage. Ann Neurol 2002;51:517–524.

    Article  PubMed  Google Scholar 

  69. Tanaka A, Yoshinaga S, Nakayama Y, Kimura M, Tomonaga M. Cerebral blood flow and clinical outcome in patients with thalamic hemorrhage: a comparison with putaminal hemorrhage. J Neurol Sci 1996;144:191–197.

    Article  PubMed  CAS  Google Scholar 

  70. Diringer MN, Adams RE, Dunford-Shore JE, Videen TO, Yundt KD, Powers WJ. Cerebral blood flow is symmetrically reduced in patients with intracerebral hemorrhage. Neurology 1998;50:A338.

    Google Scholar 

  71. Carhuapoma JR, Wang PY, Beauchamp NJ, Keyl PM, Hanley DF, Barker PB. Diffusion-weighted MRI and proton magnetic resonance spectroscopic imaging in the study of secondary neuronal injury after intracerebral hemorrhage. Stroke 2000;31:726–732.

    PubMed  CAS  Google Scholar 

  72. Zazulia AR, Diringer MN, Videen TO, et al. Hypoperfusion without ischemia surrounding acute intracerebral hemorrhage. J Cereb Blood Flow Metab 2001;21:804–810.

    Article  PubMed  CAS  Google Scholar 

  73. Mendelow AD, Bullock R, Teasdale GM, Graham DI, McCulloch J. Intracranial haemorrhage induced at arterial pressure in the rat. Part 2: short term changes in local cerebral blood flow measured by autoradiography. Neurol Res 1984;6:189–193.

    PubMed  CAS  Google Scholar 

  74. Nath FP, Kelly PT, Jenkins A, Mendelow AD, Graham DI, Teasdale GM. Effects of experimental intracerebral hemorrhage on blood flow, capillary permeability, and histochemistry. J Neurosurg 1987;66:555–562.

    PubMed  CAS  Google Scholar 

  75. Wagner KR, Xi G, Hua Y, Kleinholz M, de Courten-Myers GM, Myers RE. Early metabolic alterations in edematous perihematomal brain regions following experimental intracerebral hemorrhage. J Neurosurg 1998;88:1058–1065.

    PubMed  CAS  Google Scholar 

  76. Qureshi AI, Wilson DA, Traystman RJ. No evidence for an ischemic penumbra in massive experimental intracerebral hemorrhage. Neurology 1999;52:266–272.

    PubMed  CAS  Google Scholar 

  77. Xi G, Hua Y, Bhasin RR, Ennis SR, Keep RF, Hoff JT. Mechanisms of edema formation after intracerebral hemorrhage: effects of extravasated red blood cells on blood flow and blood-brain barrier integrity. Stroke 2001;32:2932–2938.

    PubMed  CAS  Google Scholar 

  78. Patel TR, Schielke GP, Hoff JT, Keep RF, Lorris Betz A. Comparison of cerebral blood flow and injury following intracerebral and subdural hematoma in the rat. Brain Res 1999;829:125–133.

    Article  PubMed  CAS  Google Scholar 

  79. Gong C, Hoff JT, Keep RF. Acute inflammatory reaction following experimental intracerebral hemorrhage. Brain Res 2000;871:57–65.

    Article  PubMed  CAS  Google Scholar 

  80. Poungvarin N, Bhoopat W, Viriyavejakul A, et al. Effects of dexamethasone in primary supratentorial intracerebral hemorrhage. N Engl J Med 1987;316:1229–1233.

    Article  PubMed  CAS  Google Scholar 

  81. Tellez H, Bauer RB. Dexamethasone as treatment in cerebrovascular disease. 1. A controlled study in intracerebral hemorrhage. Stroke 1973;4: 541–546.

    PubMed  CAS  Google Scholar 

  82. Italian Acute Stroke Study Group. Haemodilution in acute stroke: results of the Italian haemodilution trial. Lancet 1988;1:318–321.

    Google Scholar 

  83. Yu YL, Kumana CR, Lauder IJ, et al. Treatment of acute cerebral hemorrhage with intravenous glycerol. A double-blind, placebo-controlled, randomized trial. Stroke 1992;23:967–971.

    PubMed  CAS  Google Scholar 

  84. Cervoni L, Artico M, Salvati M, Bristot R, Franco C, Delfini R. Epileptic seizures in intracerebral hemorrhage: a clinical and prognostic study of 55 cases. Neurosurg Rev 1994;17:185–188.

    Article  PubMed  CAS  Google Scholar 

  85. Sung CY, Chu NS. Epileptic seizures in intracerebral haemorrhage. J Neurol Neurosurg Psychiatry 1989;52:1273–1276.

    PubMed  CAS  Google Scholar 

  86. Bladin CF, Alexandrov AV, Bellavance A, et al. Seizures after stroke: a prospective multicenter study. Arch Neurol 2000;57:1617–1622.

    Article  PubMed  CAS  Google Scholar 

  87. Broderick JP, Adams HP, Jr, Barsan W, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 1999;30:905–915.

    PubMed  CAS  Google Scholar 

  88. Tuhrim S, Horowitz DR, Sacher M, Godbold JH. Volume of ventricular blood is an important determinant of outcome in supratentorial intracerebral hemorrhage. Crit Care Med. 1999;27:617–621.

    Article  PubMed  CAS  Google Scholar 

  89. Kaufman HH, Schochet SS, Koss W, Herschberger J, Bernstein D. Efficacy and safety of tissue plaminogen activator. Neurosurgery 1987;20:403–407.

    Article  PubMed  CAS  Google Scholar 

  90. Deinsberger W, Hartmann M, Vogel J, et al. Local fibrinolysis and aspiration of intracerebral hematomas in rats. An experimental study using MR monitoring. Neurol Res 1998;20:349–352.

    PubMed  CAS  Google Scholar 

  91. Deinsberger W, Vogel J, Fuchs C, Auer LM, Kuschinsky W, Boker DK. Fibrinolysis and aspiration of experimental intracerebral hematoma reduces the volume of ischemic brain in rats. Neurol Res 1999;21:517–523.

    PubMed  CAS  Google Scholar 

  92. Figueroa BE, Keep RF, Betz AL, Hoff JT. Surgical management of basal ganglia hemorrhage in rat: evidence for reduce brain edema with early hematoma evacuation. Surg Form 1997;48:539–541.

    Google Scholar 

  93. Wagner KR, Xi G, Hua Y, et al. Ultra-early clot aspiration after lysis with tissue plasminogen activator in a porcine model of intracerebral hemorrhage: edema reduction and blood-brain barrier protection. J Neurosurg 1999;90:491–498.

    PubMed  CAS  Google Scholar 

  94. Rohde V, Rohde I, Thiex R, et al. Fibrinolysis therapy achieved with tissue plasminogen activator and aspiration of the liquefied clot after experimental intracerebral hemorrhage: rapid reduction in hematoma volume but intensification of delayed edema formation. J Neurosurg 2002;97:954–962.

    PubMed  CAS  Google Scholar 

  95. Batjer HH, Reisch JS, Allen BC, Plaizier LJ, Su CJ. Failure of surgery to improve outcome in hypertensive putaminal hemorrhage. A prospective randomized trial. Arch Neurol 1990;47:1103–1106.

    PubMed  CAS  Google Scholar 

  96. Juvela S, Heiskanen O, Poranen A, et al. The treatment of spontaneous intracerebral hemorrhage. A prospective randomized trial of surgical and conservative treatment. J Neurosurg 1989;70: 755–758.

    PubMed  CAS  Google Scholar 

  97. Auer LM, Deinsberger W, Niederkorn K, et al. Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: a randomized study. J Neurosurg 1989;70:530–535.

    PubMed  CAS  Google Scholar 

  98. Morgenstern LB, Frankowski RF, Shedden P, Pasterur W, Grotta JC. Surgical treatment for intracerebral hemorrhage (STICH): a single-center, randomized clinical trial. Neurology 1998;51:1359–1363.

    PubMed  CAS  Google Scholar 

  99. Zuccarello M, Brott T, Derex L, et al. Early surgical treatment for supratentorial intracerebral hemorrhage: a randomized feasibility study. Stroke 1999;30:1833–1839.

    PubMed  CAS  Google Scholar 

  100. Montes JM, Wong JH, Fayad PB, Awad IA. Stereotactic computed tomographic-guided aspiration and thrombolysis of intracerebral hematoma: protocol and preliminary experience. Stroke 2000;31:834–840.

    PubMed  CAS  Google Scholar 

  101. Lippitz BE, Mayfrank L, Spetzger U, Warnke JP, Bertalanffy H, Gilsbach JM. Lysis of basal ganglia haematoma with recombinant tissue plasminogen activator (rtPA) after stereotactic aspiration: initial results. Acta Neurochir 1994;127:157–160.

    Article  CAS  Google Scholar 

  102. Tyler D, Mandybur G. Interventional MRI-guided stereotactic aspiration of acute/subacute intracerebral hematomas. Stereotactic Funct Neurosurg 1999;72:129–135.

    Article  CAS  Google Scholar 

  103. Schaller C, Rohde V, Meyer B, Hassler W. Stereotactic puncture and lysis of spontaneous intracerebral hemorrhage using recombinant tissue-plasminogen activator. Neurosurgery 1995;36:328–333.

    Article  PubMed  CAS  Google Scholar 

  104. Morgenstern LB, Demchuk AM, Kim DH, Frankowski RF, Grotta JC. Rebleeding leads to poor outcome in ultra-early craniotomy for intracerebral hemorrhage. Neurology 2001;56:1294–1299.

    PubMed  CAS  Google Scholar 

  105. Del Bigio MR, Yan HJ, Xue M. Intracerebral infusion of a second-generation ciliary neurotrophic factor reduces neuronal loss in rat striatum following experimental intracerebral hemorrhage. J Neurolog Sci. 2001;192:53–59.

    Article  Google Scholar 

  106. Kitaoka T, Hua Y, Xi G, Hoff JT, Keep RF. Delayed argatroban treatment reduces edema in a rat model of intracerebral hemorrhage. Stroke 2002;33:3012–3018.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, University of Michigan, Ann Arbor, MI

    Guohua Xi MD, Matthew E. Fewel, Ya Hua, B. Gregory Thompson & Julian T. Hoff

  2. Department of Physiology, University of Michigan, Ann Arbor, MI

    Richard F. Keep

Authors
  1. Guohua Xi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Matthew E. Fewel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ya Hua
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. B. Gregory Thompson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Julian T. Hoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Richard F. Keep
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Guohua Xi MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Xi, G., Fewel, M.E., Hua, Y. et al. Intracerebral hemorrhage. Neurocrit Care 1, 5–18 (2004). https://doi.org/10.1385/NCC:1:1:5

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1385/NCC:1:1:5

Key Words

Search

Navigation