Targeting secondary injury in intracerebral haemorrhage--perihaematomal oedema

Nat Rev Neurol. 2015 Feb;11(2):111-22. doi: 10.1038/nrneurol.2014.264. Epub 2015 Jan 27.


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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Review

MeSH terms

  • Brain Edema / complications
  • Brain Edema / diagnosis
  • Brain Edema / pathology*
  • Brain Edema / physiopathology*
  • Cerebral Hemorrhage / complications
  • Humans
  • Prognosis
  • Risk Factors
  • Tomography, X-Ray Computed