title: Targeting secondary injury in intracerebral haemorrhage--perihaematomal oedema.
abstract: Perihaematomal oedema (PHO) is an important pathophysiological marker of secondary injury in intracerebral haemorrhage (ICH). In this Review, we describe a novel method to conceptualize PHO formation within the framework of Starling's principle of movement of fluid across a capillary wall. We consider progression of PHO through three stages, characterized by ionic oedema (stage 1) and progressive vasogenic oedema (stages 2 and 3). In this context, possible modifiers of PHO volume and their value in identifying patients who would benefit from therapies that target secondary injury are discussed; the practicalities of using neuroimaging to measure PHO volume are also considered. We examine whether PHO can be used as a predictor of neurological outcome following ICH, and we provide an overview of emerging therapies. Our discussion emphasizes that PHO has clinical relevance both as a therapeutic target, owing to its augmentation of the mass effect of a haemorrhage, and as a surrogate marker for novel interventions that target secondary injury.
authors.affiliation: Department of Neurology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Urday
authors.affiliation: Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
authors.forename: W Taylor
authors.initials: WT
authors.lastname: Kimberly
authors.affiliation: Department of Neurology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA.
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Beslow
authors.affiliation: Department of Pathology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA.
authors.forename: Alexander O
authors.initials: AO
authors.lastname: Vortmeyer
authors.affiliation: Department of Neurology, Beth Israel Deaconess Medical Centre, 330 Brookline Avenue, Boston, MA 02215, USA.
authors.forename: Magdy H
authors.initials: MH
authors.lastname: Selim
authors.affiliation: Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rosand
authors.affiliation: Department of Neurosurgery, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201-1559, USA.
authors.forename: J Marc
authors.initials: JM
authors.lastname: Simard
authors.affiliation: Department of Neurology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA.
authors.forename: Kevin N
authors.initials: KN
authors.lastname: Sheth
mesh_terms: D001929:Brain Edema / Q000150:complications / Q000175:diagnosis / Q000473:pathology* / Q000503:physiopathology*; D002543:Cerebral Hemorrhage / Q000150:complications; D006801:Humans; D011379:Prognosis; D012307:Risk Factors; D014057:Tomography, X-Ray Computed