Abstract:
BACKGROUND AND PURPOSE:Thrombin, heme oxygenase, complement, microglia activation, and leukocyte infiltration are all actively upregulated in intracerebral hemorrhage (ICH). Experimental evidence suggests that all these factors are involved in ICH-induced brain injury. This suggests a scenario whereby ICH actively (through gene and protein upregulation) induces pathways that result in brain injury. SUMMARY OF REVIEW:In this comment, we suggest a potential answer to this conundrum. The upregulation of these factors may have been an evolutionary adaptation to limit brain injury during small hematomas (microbleeds). There is evidence that low levels of thrombin and heme oxygenase limit brain injury. In contrast, the excessive upregulation of these same factors may have a harmful effect after a large hematoma. CONCLUSIONS:The mechanisms upregulated to limit brain injury after microbleeds may also induce injury after large hematomas. The effect of hematoma size on the mechanisms involved in ICH-induced brain injury and the implications of any such effect on clinical therapies merit further investigation.
journal_name
Strokejournal_title
Strokeauthors
Keep RF,Xi G,Hua Y,Hoff JTdoi
10.1161/01.STR.0000170701.41507.e1subject
Has Abstractpub_date
2005-07-01 00:00:00pages
1594-6issue
7eissn
0039-2499issn
1524-4628pii
01.STR.0000170701.41507.e1journal_volume
36pub_type
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