Astrogliosis: a Target for Intervention in Intracerebral Hemorrhage?
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REVIEW ARTICLE
Astrogliosis: a Target for Intervention in Intracerebral Hemorrhage? Sangeetha Sukumari-Ramesh & Cargill H. Alleyne Jr. & Krishnan M. Dhandapani
Received: 7 February 2012 / Revised: 23 March 2012 / Accepted: 27 March 2012 / Published online: 14 April 2012 # Springer Science+Business Media, LLC 2012
Abstract Intracerebral hemorrhage (ICH) is a debilitating neurological injury, accounting for 10–15 % of all strokes. Despite neurosurgical intervention and supportive care, the 30-day mortality rate remains ~50 %, with ICH survivors frequently displaying neurological impairments and requiring long-term assisted care. Unfortunately, the lack of medical interventions to improve clinical outcomes has led to the notion that ICH is the least treatable form of stroke. Hence, additional studies are warranted to better understand the pathophysiology of ICH. Astrogliosis is an underlying astrocytic response to a wide range of brain injuries and postulated to have both beneficial and detrimental effects. However, the molecular mechanisms and functional roles of astrogliosis remain least characterized following ICH. Herein, we review the functional roles of astrogliosis in brain injuries and raise the prospects of therapeutically targeting astrogliosis after ICH. Keywords Astrocytes . Gliosis . ICH
all strokes that occur in the USA, Europe, and Australia, as well as 20–30 % of all strokes that occur in Asian countries [1]. ICH is associated with the highest morbidity and mortality rates among stroke subtypes. Around 50 % of ICH patients die within the first month, and fewer than 20 % of survivors regain functional independence. Moreover, the incidence of ICH is expected to grow over the next decades as a result of population aging and changes in racial demographics [2]. Though chronic hypertension and amyloid angiopathy are recognized as the most common causes of primary ICH, pathological conditions such as head trauma, cerebral artery aneurysm, arteriovenous malformation, brain tumor, anticoagulant treatment, and ischemic stroke can also have hemorrhagic transformation. Despite the relatively high rate of incidence, there is no proven effective medical treatment for ICH, and the efficacy of neurosurgical intervention after ICH remains controversial [3]. The current treatment for ICH is largely supportive such as mechanical ventilation and blood pressure control. Lack of effective medical treatment options, at least in part, reflects on the poorly defined pathophysiology of the detrimental events underlying neurological injury following ICH [2, 4].
Introduction Spontaneous intracerebral hemorrhage (ICH) is a catastrophic stroke subtype, and primary ICH is responsible for 10–15 % of
Primary Brain Injury in ICH
S. Sukumari-Ramesh (*) : C. H. Alleyne Jr. : K. M. Dhandapani Department of Neurosurgery, Georgia Health Sciences University, 1120 15th Street, Augusta, GA 30912, USA e-mail: [email protected]
ICH, defined as the neurological deficit associated with a focal collection of blood within the brain par
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