Preconditioning and Intracerebral Hemorrhage

  • Richard F. KeepEmail author
  • Ya Hua
  • Guohua Xi
Part of the Springer Series in Translational Stroke Research book series (SSTSR)


Intracerebral hemorrhage (ICH) is a common and often fatal stroke subtype with more than 30,000 patients dying from spontaneous ICH in the USA each year. The causes of ICH are multiple. While spontaneous ICH is often associated with hypertension, other major causes include amyloid angiopathy, aneurysms, arteriovenous malformations, cavernous angiomas, and brain tumors. In addition, secondary cerebral hemorrhage can occur after an ischemic stroke (hemorrhagic transformation) and traumatic brain injury. In both cases, hemorrhage is associated with worse outcome.

The brain injury following an ICH has multiple components including primary injury, related to the physical trauma and the mass effect caused by the hematoma, and a variety of secondary injury mechanisms. While a number of approaches/agents have proved efficacious in preclinical studies, as yet no therapy has translated to the clinic.

Preconditioning (PC) describes a phenomenon where an event (such as ischemia) or pharmacologic agent upregulates defense mechanisms in a tissue that protect against subsequent injury. Thus, for example, a short duration of cerebral ischemia can protect against a subsequent more severe ischemic event (ischemic). PC-induced protection may occur either early after the initial PC stimulus (acute, classical PC) or only appear after several hours (delayed PC) as it relies on new protein synthesis. PC, which can impact a variety of ICH-related injury mechanisms, may be a method of reducing ICH occurrence or ICH-induced brain injury. However, while there is a wealth of data on the effects of PC on models of cerebral ischemia, there have been relatively few studies examining the effects on ICH. This chapter highlights those studies and discusses the potential uses of PC for ICH.


Brain Injury Cerebral Blood Flow Middle Cerebral Artery Occlusion Hemorrhagic Transformation Intracerebral Injection 
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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of Neurosurgery, R5018 Biomedical Science Research BuildingUniversity of MichiganAnn ArborUSA

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