Predictors of hematoma expansion predictors after intracerebral hemorrhage

Sheng Chen, Binjie Zhao, Wei Wang, Ligen Shi, Cesar Reis and Jianmin Zhang _

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Oncotarget. 2017; 8:89348-89363. https://doi.org/10.18632/oncotarget.19366

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Sheng Chen1,*, Binjie Zhao1,*, Wei Wang1,*, Ligen Shi1, Cesar Reis2,3 and Jianmin Zhang1

1 Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, PR China

2 Department of Physiology and Pharmacology, Loma Linda University, Loma Linda, California, USA

3 Department of Preventive Medicine, Loma Linda University, Loma Linda, California, USA

* The first three authors have contributed equally to the work

Correspondence to:

Jianmin Zhang, email: or [email protected]

Keywords: intracerebral hemorrhage, hematoma expansion, predictor

Received: March 24, 2017 Accepted: June 19, 2017 Published: July 18, 2017


Despite years of effort, intracerebral hemorrhage (ICH) remains the most devastating form of stroke with more than 40% 30-day mortality worldwide. Hematoma expansion (HE), which occurs in one third of ICH patients, is strongly predictive of worse prognosis and potentially preventable if high-risk patients were identified in the early phase of ICH. In this review, we summarize data from recent studies on HE prediction and classify those potential indicators into four categories: clinical (severity of consciousness disturbance; blood pressure; blood glucose at and after admission); laboratory (hematologic parameters of coagulation, inflammation and microvascular integrity status), radiographic (interval time from ICH onset; baseline volume, shape and density of hematoma; intraventricular hemorrhage; especially the spot sign and modified spot sign) and integrated predictors (9-point or 24-point clinical prediction algorithm and PREDICT A/B). We discuss those predictors’ underlying pathophysiology in HE and present opportunities to develop future therapeutic strategies.

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