title: Hematoma Expansion: Clinical and Molecular Predictors and Corresponding Pharmacological Treatment.
abstract: BACKGROUND
  Hematoma expansion is a detrimental event of intracerebral hemorrhage (ICH) which results in progressive neurologic deteriorations and poor outcomes.
  
  
  OBJECTIVE
  To summariz the current understanding of the mechanisms underlying hematoma expansion and discuss the potential approaches of treatment and prevention.
  
  
  RESULTS
  Although the exact mechanism of hematoma expansion is unclear, accumulating evidences suggest that multiple clinical markers such as coagulation/hemostasis dysfunction, higher blood pressure and BRAIN scores, higher serum glucose and/or glycosylated hemoglobin A1c, serum creatinine, Factor XIII and international normalized ratio (INR), lower serum cholesterol or LDL cholesterol, and fibrinogen, may be correlated with incidents of hematoma expansion. Furthermore, activation of several molecular pathways (i.e. plasma kallikrein, von Willebrand factor, N-methyl-Daspartate and its receptor, cytokines/ adipokines, cellular fibronectin and apolipoprotein Eε2 allele) may lead to hematoma expansion.
  
  
  CONCLUSIONS
  Prospective study for hematoma expansion How to predict the patients Who are at highest risk of hematoma expansion is more challengeable than restricting hematoma expansion itself following acute ICH. Seeking and detecting risk markers in plasma that can be intervened appropriately is meaningful for patients with potential hematoma expansion, which may contribute to improve clinical outcomes in patients suffering from ICH.
authors.affiliation: Departments of Anesthesiology and Physiology, Loma Linda University, 11041 Campus St, Risley Hall, Room 219, Loma Linda, CA 92354, USA.
authors.forename: Gaiqing
authors.initials: G
authors.lastname: Wang
authors.affiliation: Departments of Anesthesiology and Physiology, Loma Linda University, 11041 Campus St, Risley Hall, Room 219, Loma Linda, CA 92354, USA.
authors.forename: John
authors.initials: J
authors.lastname: Zhang
mesh_terms: D015415:Biomarkers / Q000378:metabolism*; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism; D002784:Cholesterol / Q000097:blood; D008078:Cholesterol, LDL / Q000009:adverse effects / Q000097:blood; D005340:Fibrinogen / Q000009:adverse effects; D005947:Glucose / Q000009:adverse effects; D006406:Hematoma / Q000209:etiology* / Q000378:metabolism* / Q000517:prevention & control; D006801:Humans; D006973:Hypertension / Q000150:complications
chemical_list: D015415:Biomarkers; D008078:Cholesterol, LDL; D005340:Fibrinogen; D002784:Cholesterol; D005947:Glucose
keywords: Hematoma expansion; intracerebral hemorrhage; molecular intervention; molecular mechanism; pharmacological treatment; predictors; prevention