Intracerebral hemorrhage (ICH) stands out among strokes, both for the severely morbid outcomes it routinely produces, and for the striking deficiency of defenses possessed against the same. The brain damage caused by ICH proceeds through multiple pathophysiological mechanisms, broadly differentiated into those considered primary, arising from the hematoma itself, and the secondary consequences of hematoma presence and expansion thereof. A number of interventions against ICH and its sequelae have been investigated (e.g., hemostatic therapies, blood pressure control, hematoma evacuation, and a variety of neuroprotective strategies), but conclusive demonstrations of clinical benefit have remained largely elusive. In this review, we begin with a description of these interventions and the trials in which they have been implemented, coupled with an attempt to account for their failure. Possible causes discussed include iatrogenic injury during hematoma evacuation, secondary injury initiated by hematoma persistence after evacuation, and inadequate therapeutic power arising from an excessively narrow focus on a single component of the complex pathophysiology of ICH injury. To conclude, we propose several strategies, such as enhancing endogenous hematoma resolution, hematoma evacuation-based neuroprotection, and multi-targeted therapy, that hold promise as prospects for the extension of anti-ICH therapy into the domain of clinical significance.

中文翻译：

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脑出血的治疗：目前的方法和未来的方向

脑出血 (ICH) 在中风中尤为突出，因为它通常会导致严重的病态结果，而且其防御能力明显不足。由 ICH 引起的脑损伤通过多种病理生理机制进行，大致分为那些被认为是原发性的，由血肿本身引起的，以及血肿存在和扩大的继发性后果。已经研究了许多针对 ICH 及其后遗症的干预措施（例如，止血疗法、血压控制、血肿清除和各种神经保护策略），但临床益处的结论性证明在很大程度上仍然难以捉摸。在这篇综述中，我们首先描述了这些干预措施及其实施的试验，再加上试图解释他们的失败。讨论的可能原因包括血肿清除过程中的医源性损伤、清除后血肿持续引起的继发性损伤，以及由于过于狭隘地关注 ICH 损伤复杂病理生理学的单一组成部分而导致的治疗能力不足。总之，我们提出了几种策略，例如增强内源性血肿消退、基于血肿清除的神经保护和多靶向治疗，这些策略有望将抗 ICH 治疗扩展到具有临床意义的领域。以及由于过于狭隘地关注 ICH 损伤复杂病理生理学的单一组成部分而导致的治疗能力不足。总之，我们提出了几种策略，例如增强内源性血肿消退、基于血肿清除的神经保护和多靶向治疗，这些策略有望将抗 ICH 治疗扩展到具有临床意义的领域。以及由于过于狭隘地关注 ICH 损伤复杂病理生理学的单一组成部分而导致的治疗能力不足。总之，我们提出了几种策略，例如增强内源性血肿消退、基于血肿清除的神经保护和多靶向治疗，这些策略有望将抗 ICH 治疗扩展到具有临床意义的领域。