title: Treatment of Edema Associated With Intracerebral Hemorrhage.
abstract: Cerebral edema (i.e., "brain swelling") is a common complication following intracerebral hemorrhage (ICH) and is associated with worse clinical outcomes. Perihematomal edema (PHE) accumulates during the first 72 h after hemorrhage, and during this period, patients are at risk of clinical deterioration due to the resulting tissue shifts and brain herniation. First-line medical therapies for patients symptomatic of PHE include osmotic agents, such as mannitol in low- or high-dose bolus form, or boluses of hypertonic saline (HTS) at varied concentrations with or without subsequent continuous infusion. Decompressive craniectomy may be required for symptomatic edema refractory to osmotherapy. Other strategies that reduce PHE such as hypothermia and minimally invasive surgery have shown promise in pilot studies and are currently being evaluated in larger clinical trials. Ongoing basic, translational, and clinical research seek to better elucidate the pathophysiology of PHE to identify novel strategies to prevent edema formation as a next major advance in the treatment of ICH.
authors.affiliation: Department of Neurology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA. audrey.leasure@yale.edu.
authors.forename: Audrey
authors.initials: A
authors.lastname: Leasure
authors.affiliation: Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. wtkimberly@mgh.harvard.edu.
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. lauren.sansing@yale.edu.
authors.forename: Lauren H
authors.initials: LH
authors.lastname: Sansing
authors.affiliation: Yale Program on Neurogenetics, Department of Neurosurgery and Pediatrics, 333 Cedar Street, New Haven, CT, 06510, USA. kristopher.kahle@yale.edu.
authors.forename: Kristopher T
authors.initials: KT
authors.lastname: Kahle
authors.affiliation: Department of Neurology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. golo.kronenberg@charite.de.
authors.forename: Golo
authors.initials: G
authors.lastname: Kronenberg
authors.affiliation: Department of Neurology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. hagen.kunte@charite.de.
authors.forename: Hagen
authors.initials: H
authors.lastname: Kunte
authors.affiliation: Department of Neurosurgery, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD, 21201-1559, USA. msimard@smail.umaryland.edu.
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. kevin.sheth@yale.edu.
authors.forename: Kevin N
authors.initials: KN
authors.lastname: Sheth
keywords: Hyperosmolar therapy; ICP; Intracerebral hemorrhage; Perihematomal edema; Secondary brain injury