脑出血(ICH)是一种严重的中风,死亡率高(死亡率40%)。出血性中风的患病率在全球范围内有所增加,随着抗凝剂的使用和高血压治疗的改善,根本原因随着时间的推移而发生变化。ICH的基本病因和ICH的危害机制,特别是水肿之间复杂的相互作用,炎症,和血液制品毒性,已由美国心脏协会(AHA)在2022年进行了彻底修订。尽管许多试验研究了ICH的最佳药物和手术治疗方法,在生存和功能测试方面仍然没有明显的改善。小血管疾病,如脑淀粉样血管病(CAA)或深穿支动脉病(高血压动脉病),是自发性非创伤性脑出血(ICH)的最常见原因。即使ICH只导致10%-15%的中风,它大大有助于发病率和死亡率,很少有急性或预防性治疗被证明是有效的。目前的AHA指南承认,对未增强的脑CT的敏感性高达89%,对脑MRI的敏感性高达81%。两种方法的影像学表现有助于初步诊断和随访,有时需要在入院后几小时,特别是用于检测出血性转化或血肿扩张。这篇综述总结了出血性中风流行病学的基本主题,危险因素,病理生理学,损伤机制,当前的管理方法,神经影像学的发现,目标和结果,改善生活方式的建议,以及ICH未来的研究方向。每个主题都包含更新的参考文献列表。
Intracerebral hemorrhage (ICH) is a severe stroke with a high death rate (40% mortality). The prevalence of hemorrhagic stroke has increased globally, with changes in the underlying cause over time as anticoagulant use and hypertension treatment have improved. The fundamental etiology of ICH and the mechanisms of harm from ICH, particularly the complex interaction between edema, inflammation, and blood product toxicity, have been thoroughly revised by the American Heart Association (AHA) in 2022. Although numerous trials have investigated the best medicinal and surgical management of ICH, there is still no discernible improvement in survival and functional tests. Small vessel diseases, such as cerebral amyloid angiopathy (CAA) or deep perforator arteriopathy (hypertensive arteriopathy), are the most common causes of spontaneous non-traumatic intracerebral hemorrhage (ICH). Even though ICH only causes 10%-15% of all strokes, it contributes significantly to morbidity and mortality, with few acute or preventive treatments proven effective. Current AHA
guidelines acknowledge up to 89% sensitivity for unenhanced brain CT and 81% for brain MRI. The imaging findings of both methods are helpful for initial diagnosis and follow-up, sometimes necessary a few hours after admission, especially for detecting hemorrhagic transformation or hematoma expansion. This review summarized the essential topics on hemorrhagic stroke epidemiology, risk factors, physiopathology, mechanisms of injury, current management approaches, findings in neuroimaging, goals and outcomes, recommendations for lifestyle modifications, and future research directions ICH. A list of updated references is included for each topic.