Review Article - Current status of osmotherapy in intracerebral hemorrhage

Intracerebral hemorrhage (ICH) is defined as bleeding into the brain parenchyma that may extend into the ventricles and in rare cases into the subarachnoid space. It is the most common form of hemorrhagic stroke representing 10-15% of all strokes and results in more deaths or major disability than due to cerebral infarction. Only 38% of affected patients survive one year.¹ The annual incidence of ICH is approximately 10-20/lac individuals and has remained essentially unchanged over the past two decades. The reported incidence of ICH among the Asian population is higher than among the whites in USA and Europe. Advancing age, hypertension, alcoholism, low serum cholesterol, amyloid angiopathy, arteriovenous malformation, ruptured aneurysm, coagulation disorder and drug abuse are important risk factors for spontaneous ICH.² Earlier, hypertensive ICH was considered to be a monophasic event, but lately it has been shown by CT scan that hematoma can slowly expand over time and can even be recurrent.³ In a study of 103 patients with ICH, the hematoma expanded in 26% patients within 1 hour and in another 12% within 20 hours.⁴ The enlargement of hematoma has been attributed to continued bleeding, mechanical disruption of surrounding vessel, acute hypertension or a local coagulation deficit.