Intracerebral haemorrhage expansion: definitions, predictors, and prevention

Haematoma expansion affects a fifth of patients within 24 h of the onset of acute intracerebral haemorrhage and is associated with death and disability, which makes it an appealing therapeutic target. The time in which active intervention can be done is short as expansion occurs mostly within the first 3 h after onset. Baseline haemorrhage volume, antithrombotic treatment, and CT angiography spot signs are each associated with increased risk of haematoma expansion. Non-contrast CT features are promising predictors of haematoma expansion, but their potential contribution to current models is under investigation. Blood pressure lowering and haemostatic treatment minimise haematoma expansion but have not led to improved functional outcomes in randomised clinical trials. Ultra-early enrolment and selection of participants on the basis of non-contrast CT imaging markers could focus future clinical trials to show clinical benefit in people at high risk of expansion or investigate heterogeneity of treatment effects in clinical trials with broad inclusion criteria.

Automated summary

Haematoma expansion occurs in a significant portion of patients with acute intracerebral haemorrhage within 24 hours of onset and is associated with negative outcomes. Factors such as baseline haemorrhage volume, antithrombotic treatment, and CT angiography spot signs increase the risk of haematoma expansion. Non-contrast CT features show promise as predictors, but their contribution to current models is still being investigated. Blood pressure lowering and haemostatic treatment can reduce haematoma expansion, but their impact on functional outcomes is inconclusive based on clinical trials. Future trials should focus on early enrolment and selecting participants based on non-contrast CT imaging markers to demonstrate clinical benefits in high-risk individuals or investigate treatment effects in a more diverse population.