Update in Intracerebral Hemorrhages - Part 2: Patients at Risk Associated with Vascular Lesions

at risk of experiencing untreated brain arteriovenous malformations (bAVM) [7], and patients with brain stem cavernoma [8] dealing with ICH due to vascular lesions. The first paper summarizes demographic and clinical characteristics of IVH patients with and without an underlying vascular lesion, and among cohorts with different vascular lesions prospectively collected in the CLEAR III clinical trial for eligibility of clot lysis [6]. IVH is associated with high rates of mortality and morbidity, often suggested to result from non-existing vascular lesions, which influences interventional treatment and may reduce prognosis through further rebleeding. A total of 10,538 consecutive IVH cases were prospectively screened for the trial between 2011 and 2015. Out of these, 496 cases (4.7%) screened negative for the underlying vascular lesion, met the inclusion criteria, and were enrolled in the trial (no vascular etiology group); and 1,205 cases (11.4%) were concurrently screened and excluded from the trial because of a demonstrated underlying vascular lesion (vascular etiology group). Cases with vascular lesion were less likely to be >45 years of age (OR 0.28, 95% CI 0.20–0.40), African-American (OR 0.23, 95% CI 0.18–0.31), or male gender (OR 0.48, 95% CI 0.38–0.60), and more likely to present with primary IVH (OR 1.85, 95% CI 1.37–2.51) compared to those with no vascular etiology ( p < 0.001). The authors concluded that an underlying vascular lesion as etiology of IVH should not be excluded solely by demographic parameters but needed better forms of vascular imaging in screening patients before contemplating interventions like intravenIn my recent Editorial [1], 3 outstanding original papers on intracerebral hemorrhages (ICH) have been published under the heading “Highlights in this issue ” [2–4]. To illustrate our heterogeneous and limited knowledge of this less frequent and still underestimated stroke subtype – whether primary or secondary in etiology – we present a second series of recent submissions from different parts of the world. We start with an excellent review by Lattanzi et al. [5] from Italy on a still controversial issue – the optimal treatment of high blood pressure (BP) after acute intra-cerebral hemorrhage (for free access online). This review strongly supports current evidence from 5 trials involving 4,350 participants – 2,162 and 2,188 for intensive and conservative treatment groups respectively. The pooled risk ratio of 3-month death or major disability was 0.96 (0.91–1.01) and the weighted mean difference in absolute hematoma growth was –1.53 (95% CI –2.94 to –0.12) mL in the intensive group compared to the conservative group in terms of the treatment given to lower BP. Thus, despite lack of significant results in terms of morbidity and severe mortality, intensive anti-hypertensive treatment was safe and it significantly reduced the hematoma expansion in patients presenting with acute-onset spontaneous ICH and high BP levels; long-term clinical benefits may well be associated but have not been investigated as yet. Three new original papers present information on three special groups – patients at very high risk of experiencing intraventricular hemorrhages (IVH) [6] , children Published online: May 23, 2017