Intracerebral Hemorrhage

ABSTRACT

Intracerebral hemorrhage has recently transitioned from being a neurosurgical entity into a condition where nonsurgeons have more participation in the medical decision making. Despite recent advances in the management of intracerebral hemorrhage (i.e., STICH trial and recombinant factor VII trial), guidelines published in 1999 remain the only available therapeutic consensus. The goal of this review is to address frequently encountered case scenarios when managing patients with spontaneous or nontraumatic intracerebral hemorrhage, both acutely and long-term.

Intracerebral hemorrhage - anticoagulants - antithrombotic therapy - thrombolysis - microbleeds

REFERENCES

• 1 Brown D L, Boden-Albala B, Langa K M et al.. Projected costs of ischemic stroke in the United States [see comment].  Neurology. 2006;  67 1390-1395
• 2 Russell M W, Joshi A V, Neumann P J, Boulanger L, Menzin J. Predictors of hospital length of stay and cost in patients with intracerebral hemorrhage.  Neurology. 2006;  67 1279-1281
• 3 Taylor T N, Davis P H, Torner J C et al.. Lifetime cost of stroke in the United States.  Stroke. 1996;  27 1459-1466
• 4 Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group [see comment].  N Engl J Med. 1995;  333 1581-1587
• 5 Derex L, Hermier M, Adeleine P et al.. Clinical and imaging predictors of intracerebral haemorrhage in stroke patients treated with intravenous tissue plasminogen activator.  J Neurol Neurosurg Psychiatry. 2005;  76 70-75
• 6 Demchuk A M, Morgenstern L B, Krieger D W et al.. Serum glucose level and diabetes predict tissue plasminogen activator-related intracerebral hemorrhage in acute ischemic stroke.  Stroke. 1999;  30 34-39
• 7 Warach S, Latour L L. Evidence of reperfusion injury, exacerbated by thrombolytic therapy, in human focal brain ischemia using a novel imaging marker of early blood-brain barrier disruption.  Stroke. 2004;  35(suppl 1) 2659-2661
• 8 Mahaffey K W, Granger C B, Sloan M A et al.. Risk factors for in-hospital nonhemorrhagic stroke in patients with acute myocardial infarction treated with thrombolysis: results from GUSTO-I.  Circulation. 1998;  97 757-764
• 9 Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Fibrinolytic Therapy Trialists' (FTT) Collaborative Group [see comment] [erratum appears in Lancet 1994;343(8899):742].  Lancet. 1994;  343 311-322
• 10 Gebel J M, Brott T G, Sila C A et al.. Decreased perihematomal edema in thrombolysis-related intracerebral hemorrhage compared with spontaneous intracerebral hemorrhage.  Stroke. 2000;  31 596-600
• 11 Lee K R, Kawai N, Kim S, Sagher O, Hoff J T. 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
• 12 Lee K R, Colon G P, Betz A L et al.. Edema from intracerebral hemorrhage: the role of thrombin.  J Neurosurg. 1996;  84 91-96
• 13 Dzialowski I, Pexman J H, Barber P A et al.. Asymptomatic hemorrhage after thrombolysis may not be benign: prognosis by hemorrhage type in the Canadian Alteplase for Stroke Effectiveness Study Registry.  Stroke. 2007;  38 75-79
• 14 Hallenbeck J M, Dutka A J. Background review and current concepts of reperfusion injury [erratum appears in Arch Neurol 1991;48(8):811].  Arch Neurol. 1990;  47 1245-1254
• 15 Mahaffey K W, Granger C B, Sloan M A et al.. Neurosurgical evacuation of intracranial hemorrhage after thrombolytic therapy for acute myocardial infarction: experience from the GUSTO-I trial. Global Utilization of Streptokinase and tissue-plasminogen activator (tPA) for Occluded Coronary Arteries.  Am Heart J. 1999;  138 493-499
• 16 Manno E M, Atkinson J L, Fulgham J R, Wijdicks E F. Emerging medical and surgical management strategies in the evaluation and treatment of intracerebral hemorrhage.  Mayo Clin Proc. 2005;  80 420-433
• 17 Mendelow A D, Gregson B A, Fernandes H M et al.. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial [see comment].  Lancet. 2005;  365 387-397
• 18 Rabinstein A A, Wijdicks E F. Surgery for intracerebral hematoma: the search for the elusive right candidate.  Rev Neurol Dis. 2006;  3 163-172
• 19 Broderick J P, Adams Jr H P, 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
• 20 Mayer S A, Brun N C, Begtrup K et al.. Recombinant activated factor VII for acute intracerebral hemorrhage.  N Engl J Med. 2005;  352 777-785
• 21 Flaherty M L, Haverbusch M, Sekar P et al.. The increasing burden of anticoagulant-associated intracerebral hemorrhage[abstract].  Stroke. 2006;  37 623. Abstract 15
• 22 Kucher N, Castellanos L R, Quiroz R et al.. Time trends in warfarin-associated hemorrhage.  Am J Cardiol. 2004;  94 403-406
• 23 Aguilar M I, Hart R G, Kase C S et al.. Treatment of warfarin-associated intracerebral hemorrhage: literature review and expert opinion.  Mayo Clin Proc. 2007;  82 82-92
• 24 Baker R I, Coughlin P B, Gallus A S et al.. Warfarin reversal: consensus guidelines, on behalf of the Australasian Society of Thrombosis and Haemostasis [see comment] [erratum appears in Med J Aust 2005;182(1):48].  Med J Aust. 2004;  181 492-497
• 25 Ansell J, Hirsh J, Poller L et al.. The pharmacology and management of the vitamin K antagonists: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.  Chest. 2004;  126(suppl) 204S-233S
• 26 Schulman S. Clinical practice: care of patients receiving long-term anticoagulant therapy.  N Engl J Med. 2003;  349 675-683
• 27 Goldstein J N, Thomas S H, Frontiero V et al.. Timing of fresh frozen plasma administration and rapid correction of coagulopathy in warfarin-related intracerebral hemorrhage.  Stroke. 2006;  37 151-155
• 28 Butler A C, Tait R C. Restarting anticoagulation in prosthetic heart valve patients after intracranial haemorrhage: a 2-year follow-up.  Br J Haematol. 1998;  103 1064-1066
• 29 Lau C P, Chang C M, Lau G K et al.. Cerebral haemorrhage in anticoagulated patients with non-septic mechanical valvular prosthesis.  Int J Cardiol. 1991;  30 289-296
• 30 Nagano N, Tabata H, Hashimoto K. Anticoagulant-related intracerebral hemorrhage in patients with prosthetic heart valves: report of two cases.  Neurol Med Chir (Tokyo). 1991;  31 743-745
• 31 Nakagawa T, Kubota T, Handa Y, Kawano H, Sato K. Intracranial hemorrhage due to long-term anticoagulant therapy in patients with prosthetic heart valves: four case reports.  Neurol Med Chir (Tokyo). 1995;  35 156-159
• 32 Punthakee X, Doobay J, Anand S S. Oral-anticoagulant-related intracerebral hemorrhage.  Thromb Res. 2002;  108 31-36
• 33 Koennecke H C. Cerebral microbleeds on MRI: prevalence, associations, and potential clinical implications.  Neurology. 2006;  66 165-171
• 34 Eckman M H, Rosand J, Knudsen K A, Singer D E, Greenberg S M. Can patients be anticoagulated after intracerebral hemorrhage? A decision analysis.  Stroke. 2003;  34 1710-1716
• 35 Wani M, Nga E, Navaratnasingham R. Should a patient with primary intracerebral haemorrhage receive antiplatelet or anticoagulant therapy?.  BMJ. 2005;  331 439-442
• 36 Moulin T, Crepin-Leblond T, Chopard J L, Bogousslavsky J. Hemorrhagic infarcts.  Eur Neurol. 1994;  34 64-77
• 37 Lyden P D, Zivin J A. Hemorrhagic transformation after cerebral ischemia: mechanisms and incidence.  Cerebrovasc Brain Metab Rev. 1993;  5 1-16
• 38 Amarenco P, Labreuche J, Lavallee P, Touboul P J. Statins in stroke prevention and carotid atherosclerosis: systematic review and up-to-date meta-analysis.  Stroke. 2004;  35 2902-2909
• 39 Amarenco P, Bogousslavsky J, Callahan III A et al.. High-dose atorvastatin after stroke or transient ischemic attack [see comment].  N Engl J Med. 2006;  355 549-559
• 40 Collins R, Armitage J, Parish S et al.. Effects of cholesterol-lowering with simvastatin on stroke and other major vascular events in 20536 people with cerebrovascular disease or other high-risk conditions [see comment].  Lancet. 2004;  363 757-767
• 41 Expert Panel on Detection EaToHBCiA . Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) [see comment].  JAMA. 2001;  285 2486-2497
• 42 Sacco R L, Adams R, Albers G et al.. Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: co-sponsored by the Council on Cardiovascular Radiology and Intervention.  Stroke. 2006;  37 577-617
• 43 Fazekas F, Kleinert R, Roob G et al.. Histopathologic analysis of foci of signal loss on gradient-echo T2*-weighted MR images in patients with spontaneous intracerebral hemorrhage: evidence of microangiopathy-related microbleeds.  AJNR Am J Neuroradiol. 1999;  20 637-642
• 44 Roob G, Schmidt R, Kapeller P et al.. MRI evidence of past cerebral microbleeds in a healthy elderly population.  Neurology. 1999;  52 991-994
• 45 Osborn A G. Diagnostic Neuroradiology. St. Louis, MO; Mosby 1994
• 46 Fan Y H, Mok V C, Lam W W, Hui A C, Wong K S. Cerebral microbleeds and white matter changes in patients hospitalized with lacunar infarcts.  J Neurol. 2004;  251 537-541
• 47 Kato H, Izumiyama M, Izumiyama K, Takahashi A, Itoyama Y. Silent cerebral microbleeds on T2*-weighted MRI: correlation with stroke subtype, stroke recurrence, and leukoaraiosis.  Stroke. 2002;  33 1536-1540
• 48 Kwa V I, Franke C L, Verbeeten Jr B, Stam J. Silent intracerebral microhemorrhages in patients with ischemic stroke. Amsterdam Vascular Medicine Group [see comment].  Ann Neurol. 1998;  44 372-377
• 49 Greenberg S M, Eng J A, Ning M, Smith E E, Rosand J. Hemorrhage burden predicts recurrent intracerebral hemorrhage after lobar hemorrhage.  Stroke. 2004;  35 1415-1420
• 50 Naka H, Nomura E, Wakabayashi S et al.. Frequency of asymptomatic microbleeds on T2*-weighted MR images of patients with recurrent stroke: association with combination of stroke subtypes and leukoaraiosis.  AJNR Am J Neuroradiol. 2004;  25 714-719
• 51 Wong K S, Chan Y L, Liu J Y, Gao S, Lam W W. Asymptomatic microbleeds as a risk factor for aspirin-associated intracerebral hemorrhages.  Neurology. 2003;  60 511-513
• 52 Kidwell C S, Saver J L, Villablanca J P et al.. Magnetic resonance imaging detection of microbleeds before thrombolysis: an emerging application [see comment].  Stroke. 2002;  33 95-98
• 53 Derex L, Nighoghossian N, Hermier M et al.. Thrombolysis for ischemic stroke in patients with old microbleeds on pretreatment MRI.  Cerebrovasc Dis. 2004;  17 238-241
• 54 Ferro J M. Update on intracerebral haemorrhage.  J Neurol. 2006;  253 985-999
• 55 Greenberg S M, Rebeck G W, Vonsattel J P, Gomez-Isla T, Hyman B T. Apolipoprotein E epsilon 4 and cerebral hemorrhage associated with amyloid angiopathy [see comment].  Ann Neurol. 1995;  38 254-259
• 56 Knudsen K A, Rosand J, Karluk D, Greenberg S M. Clinical diagnosis of cerebral amyloid angiopathy: validation of the Boston criteria.  Neurology. 2001;  56 537-539
• 57 Gregory P C, Kuhlemeier K V. Prevalence of venous thromboembolism in acute hemorrhagic and thromboembolic stroke.  Am J Phys Med Rehabil. 2003;  82 364-369
• 58 Lacut K, Bressollette L, Le Gal G et al.. Prevention of venous thrombosis in patients with acute intracerebral hemorrhage.  Neurology. 2005;  65 865-869
• 59 Dickmann U, Voth E, Schicha H et al.. Heparin therapy, deep-vein thrombosis and pulmonary embolism after intracerebral hemorrhage.  Klin Wochenschr. 1988;  66 1182-1183
• 60 Counsell C, Boonyakarnkul S, Dennis M et al.. Primary intracerebral haemorrhage in the Oxfordshire Community Stroke Project.  Cerebrovasc Dis. 1995;  5 26-34
• 61 The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke. International Stroke Trial Collaborative Group [see comment].  Lancet. 1997;  349 1569-1581
• 62 McCarthy S T, Turner J. Low-dose subcutaneous heparin in the prevention of deep-vein thrombosis and pulmonary emboli following acute stroke.  Age Ageing. 1986;  15 84-88
• 63 Lacut K, Bressollette L, Le Gal G et al.. Prevention of venous thrombosis in patients with acute intracerebral hemorrhage.  Neurology. 2005;  65 865-869
• 64 Geerts W H, Pineo G F, Heit J A. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.  Chest. 2004;  126(suppl) 338S-400S