Advance in Etiology of Non-hypertensive Cerebral Hemorrhage

doi:10.3969/j.issn.1673-5765.2019.01.011

Abstract

Abstract:

Non-hypertensive intracerebral hemorrhage has various causes. Cerebrovascular structural abnormality such as arteriovenous malformation, cavernous hemangioma, aneurysm and venous dysplasia may increase the risk of cerebral hemorrhage by changing the local vascular structure and hemodynamics; the use of anticoagulants and thrombolytic drugs may lead to intracerebral hemorrhage by disturbing the normal blood clotting state of patients; the other drugs such as antidepressants may bring about a potential risk of intracerebral hemorrhage, while the underlying mechanism remains unclear; in addition, many studies have showed some systemic factors may be involved in intracerebral hemorrhage, such as abnormal blood sugar, liver dysfunction, and even growth exposure in childhood. This article reviewed that the advance in the etiology of non-hypertensive intracerebral hemorrhage.

Key words: Intracerebral hemorrhage; Etiology; Biomarker

摘要：

在非高血压性ICH病因中，脑血管结构病变如脑AVMs、海绵状血管瘤、rete MCA等可能通过病变局部血管结构及血流动力学的变化导致患者ICH风险增加；抗凝药和溶栓药物的应用可能通过改变患者血液凝结状态导致ICH；目前还发现抗抑郁药物等其他药物也有潜在导致患者ICH发生的风险，其机制尚不明确。研究还发现，一些全身性因素如血糖异常、肝功能异常，甚至儿童时期的生长暴露也可能影响患者的ICH风险。

关键词: 脑出血; 病因学; 生物学标志物

WANG Xi-Xi, ZHANG Yu-Lei, WU Yun-Cheng. Advance in Etiology of Non-hypertensive Cerebral Hemorrhage[J]. Chinese Journal of Stroke, 2019, 14(01): 58-62.

王茜茜，张雨蕾，吴云成. 非高血压脑出血病因学研究进展[J]. 中国卒中杂志, 2019, 14(01): 58-62.

References

[1] MERETOJA A，STRBIAN D，PUTAALA J，et al.

SMASH-U：a proposal for etiologic classification of

intracerebral hemorrhage[J]. Stroke，2012，43（10）：

2592-2597.

[2] MOUCHTOURIS N，JABBOUR P M，STARKE

R M，et al. Biology of cerebral arteriovenous

malformations with a focus on inflammation[J]. J

Cereb Blood Flow Metab，2015，35（2）：167-175.

[3] CHO K C，KIM J J，JANG C K，et al. Rete middle

cerebral artery anomalies：a unifying name，case

series，and literature review[J/OL]. J Neurosurg，

2018：1-9. https：//doi.org/10.3171/2018.2.JNS1832.

[4] GIRARD R，ZEINEDDINE H A，FAM M D，et al.

Plasma biomarkers of inflammation reflect seizures

and hemorrhagic activity of cerebral cavernous

malformations[J]. Transl Stroke Res，2018，9（1）：

34-43.

[5] LIN C M，ARISHIMA H，KIKUTA K I，et al.

Pathological examination of cerebral amyloid

angiopathy in patients who underwent removal of

lobar hemorrhages[J]. J Neurol，2018，265（3）：567-

577.

[6] The Hemorrhagic Stroke Academia Industry

（HEADS）Roundtable Participants. Basic and

translational research in intracerebral hemorrhage：

limitations，priorities，and recommendations[J].

Stroke，2018，49（5）：1308-1314.

[7] HAN B H，ZHOU M L，JOHNSON A W，et al.

Contribution of reactive oxygen species to cerebral

amyloid angiopathy，vasomotor dysfunction，and

microhemorrhage in aged Tg2576 mice[J/OL]. Proc

Natl Acad Sci U S A，2015，112（8）：E881-E890.

https：//doi.org/10.1073/pnas.1414930112.

[8] QU J，CHEN W，HU R，et al. The Injury and

Therapy of Reactive Oxygen Species in Intracerebral

Hemorrhage Looking at Mitochondria[J/OL]. Oxid

Med Cell Longev，2016，2016：2592935. https：//doi.

org/10.1155/2016/2592935.

[9] INOUE Y，UEDA M，TASAKI M，et al. Sushi

repeat-containing protein 1：a novel diseaseassociated

molecule in cerebral amyloid

angiopathy[J]. Acta Neuropathological，2017，134

（4）：605-617.

[10] VAN ETTEN E S，VERBEEK M M，VAN DER

GROND J，et al. β-Amyloid in CSF：Biomarker

for preclinical cerebral amyloid angiopathy[J].

Neurology，2017，88（2）：169-176.

[11] BÉJOT Y，CORDONNIER C，DURIER J，et al.

Intracerebral haemorrhage profiles are changing：

results from the Dijon population-based study[J].

Brain，2013，136（2）：658-664.

[12] HART R G，TONARELLI S B，PEARCE L A.

Avoiding central nervous system bleeding during

antithrombotic therapy：recent data and ideas[J].

Stroke，2005，36（7）：1588-1593.

[13] GARCÍA-RODRÍGUEZ L A，GAIST D，MORTON

J，et al. Antithrombotic drugs and risk of

hemorrhagic stroke in the general population[J].

Neurology，2013，81（6）：566-574.

[14] TSIVGOULIS G，LIOUTAS V A，VARELAS

P，et al. Direct oral anticoagulant- vs vitamin

K antagonist-related nontraumatic intracerebral

hemorrhage[J]. Neurology，2017，89（11）：1142-

1151.

[15] MEGA J L，BRAUNWALD E，WIVIOTT S D，et al.

Rivaroxaban in patients with a recent acute coronary

syndrome[J]. N Engl J Med，2012，366（1）：9-19.

[16] INZITARI D，GIUSTI B，NENCINI P，et al. MMP9

variation after thrombolysis is associated with

hemorrhagic transformation of lesion and death[J].

Stroke，2013，44（10）：2901-2903.

[17] TSIVGOULIS G，ZAND R，KATSANOS A H，et

al. Risk of symptomatic intracerebral hemorrhage

after intravenous thrombolysis in patients with acute

ischemic stroke and high cerebral microbleed burden：

a meta-analysis[J]. JAMA Neurol，2016，73（6）：

675-683.

[18] CAPPELLARI M，TURCATO G，FORLIVESI

S，et al. STARTING-SICH nomogram to predict

symptomatic intracerebral hemorrhage after

intravenous thrombolysis for stroke[J]. Stroke，2018，

49（2）：397-404.

[19] KHAROFA J，SEKAR P，HAVERBUSCH M，et al.

Selective serotonin reuptake inhibitors and risk of hemorrhagic stroke[J]. Stroke，2007，38（11）：3049-

3051.

[20] HACKAM D G，MRKOBRADA M. Selective

serotonin reuptake inhibitors and brain hemorrhage：

a meta-analysis[J]. Neurology，2012，79（18）：1862-

1865.

[21] JIN C，LI G，REXRODE K M，et al. Prospective

study of fasting blood glucose and intracerebral

hemorrhagic risk[J]. Stroke，2018，49（1）：27-33.

[22] SUREKA B，BANSAL K，PATIDAR Y，et al.

Neurologic manifestations of chronic liver disease

and liver cirrhosis[J]. Curr Probl Diagn Radiol，2015，

44（5）：449-461.

[23] LAI C H，CHENG P Y，CHEN Y Y. Liver cirrhosis

and risk of intracerebral hemorrhage：a 9-year

follow-up study[J]. Stroke，2011，42（9）：2615-2617.

[24] CHOW F C，HE W，BACCHETTI P，et al. Elevated

rates of intracerebral hemorrhage in individuals from

a US clinical care HIV cohort[J]. Neurology，2014，

83（19）：1705-1711.

[25] CONNOR M D，LAMMIE G A，BELL J E，et

al. Cerebral infarction in adult AIDS patients：

observations from the Edinburgh HIV Autopsy

Cohort[J]. Stroke，2000，31（9）：2117-2126.

[26] GUTIERREZ J，ELKIND M S，PETITO C，et al.

The contribution of HIV infection to intracranial

arterial remodeling：a pilot study[J]. Neuropathology，

2013，33（3）：256-263.

[27] COLE J W，CHIN J H. HIV infection：a new risk

factor for intracerebral hemorrhage?[J]. Neurology，

2014，83（19）：1690-1691.

[28] GJAERDE L K，TRUELSEN T C，BAKER J L.

Childhood stature and growth in relation to first

ischemic stroke or intracerebral hemorrhage[J].

Stroke，2018，49（3）：579-585.

[29] JICKLING G C，ANDER B P，STAMOVA B，et

al. RNA in blood is altered prior to hemorrhagic

transformation in ischemic stroke[J]. Ann Neurol，

2013，74（2）：232-240.

[30] JEANNE M，JORGENSEN J，GOULD D B.

Molecular and genetic analyses of collagen type IV

mutant mouse models of spontaneous intracerebral

hemorrhage identify mechanisms for stroke

prevention[J]. Circulation，2015，131（18）：1555-

1565.

[31] CARPENTER A M，SINGH I P，GANDHI C D，et

al. Genetic risk factors for spontaneous intracerebral

haemorrhage[J]. Nat Rev Neurol，2016，12（1）:40-

49.