Early Hematoma Enlargement in Primary Intracerebral Hemorrhage

Background: Early hematoma growth is not uncommon in patients with intracerebral hemorrhage. It is a devastating complication that independently predicts poor outcome. The early hematoma enlargement is usually defined as an absolute increase in hematoma volume of greater than 33% on repeat CT scan. To date, no ideal animal model can mimic the exact pathophysiological process of early hematoma growth. Objective: This review of early hematoma enlargement in primary intracerebral hemorrhage discusses definitions, pathophysiology, risk factors, and novel treatment options aimed at improving outcomes. Conclusion: Novel imaging predictors such as CT angiography spot sign and CT blend sign may predict early hematoma growth in patients with intracerebral hemorrhage. Monitoring and modulation of blood pressure may improve outcomes. Rapid reduction of blood pressure to <140 mm Hg may be safe in patients with intracerebral hemorrhage.