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Intracranial Hemorrhage: Advances in Diagnosis, Management and Treatment

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: 15 June 2026 | Viewed by 1964

Special Issue Editor


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Guest Editor
Department of Neurosurgery, Kochi Medical School Hospital, Nankoku, Japan
Interests: subarachnoid hemorrhage; intracranial aneurysm; cerebral arteriovenous malformation; cerebral vessel bypass surgery; skull base surgery; combined direct and endovascular surgery; stroke epidemiology

Special Issue Information

Dear Colleagues,

Intracranial hemorrhage (ICH), which commonly includes intracerebral (intraparenchymal) hemorrhage, subarachnoid hemorrhage, and traumatic intracranial hemorrhage, is associated with high mortality and morbidity. In general, survivors suffer from persistent neurological deficits because of destruction to the surrounding brain tissues. Although the prevalence of ICH has decreased in recent years due to strict blood pressure control, once ICH has developed, the prognosis has not improved significantly for several decades. Unlike mechanical thrombectomy for large vessel occlusion, which has dramatically improved outcomes in cerebral infarction, the treatment of intracerebral hemorrhage may not see a single breakthrough that improves prognosis. Instead, the accumulation of small advances, from multidisciplinary perspectives in the clinical course of ICH, including prehospital care, less invasive intervention, development in the treatment of culprit vascular malformations, neurocritical care, rehabilitation, and pharmacological approaches to brain edema and elevated blood pressure, could improve ICH prognosis. As part of the following Special Issue, we welcome authors to submit papers on clinical advances in the treatment of ICH in prehospital care, interventional treatment, culprit vascular malformation, efficient drugs, neurocritical care, and rehabilitation.

Dr. Hitoshi Fukuda
Guest Editor

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Keywords

  • intracerebral hemorrhage
  • subarachnoid hemorrhage
  • traumatic hemorrhage
  • prehospital care
  • less invasive surgery
  • vascular malformation
  • antihypertensive drug
  • intracranial pressure elevation
  • decompressive craniectomy
  • neurocritical care
  • nursing care
  • rehabilitation

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Published Papers (2 papers)

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Research

15 pages, 2180 KB  
Article
Is Dexamethasone Helpful in Reducing Perihematoma Edema and for the Outcome of Intracerebral Hemorrhage?
by Jayantee Kalita, Sandeep Kumar Gupta, Dhiraj Kumar, Firoz M. Nizami, Prakash C. Pandey, Roopali Mahajan and Vivek Singh
J. Clin. Med. 2026, 15(1), 352; https://doi.org/10.3390/jcm15010352 - 2 Jan 2026
Viewed by 449
Abstract
Background: In primary supratentorial intracerebral hemorrhage (PSICH), dexamethasone (Dexa) may be effective in reducing perihematoma edema (PHE). We compare the changes in the PHE, hematoma edema complex (HEC), and midline shift (MLS) in patients with PSICH in the Dexa and Non-Dexa groups. Methods: [...] Read more.
Background: In primary supratentorial intracerebral hemorrhage (PSICH), dexamethasone (Dexa) may be effective in reducing perihematoma edema (PHE). We compare the changes in the PHE, hematoma edema complex (HEC), and midline shift (MLS) in patients with PSICH in the Dexa and Non-Dexa groups. Methods: The CT-proven PSICHs were included, and their stroke risk factors, Glasgow Coma Scale (GCS) score, and National Institute of Health Stroke Scale (NIHSS) score were noted. Thirty-one patients received intravenous dexamethasone from day 4 to day 7 of stroke in a dose of 24 mg, 12 mg, and 8 mg daily for 3 days each. Thirty-three patients did not receive dexamethasone. The primary outcome was the change in PHE, HEC, and MLS at 15 days compared to the pre-Dexa CT scan, and the secondary outcomes were death and disability at 3 months and side effects. Results: The Dexa group had a higher volume of ICH, HEC, and PHE, and MLS compared to the Non-Dexa group, although their age, NIHSS and GCS scores were comparable at admission and just before intervention. The Dexa group had a larger reduction in HEC (p = 0.03) and MLS (p < 0.01) compared to the Non-Dexa group. The change in PHE volume was also insignificantly higher in the Dexa group (p = 0.36). At 3 months, the patients with medium (p < 0.001) and large-size hematomas (p < 0.001) in the Dexa group had a good outcome, but this benefit was not observed in small hematomas. Conclusions: In PSICH, dexamethasone after 3 days reduces the HEC and MLS and may have survival and disability benefits especially in medium and large hematomas. A multicentric–randomized–controlled trial may confirm these findings. Full article
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13 pages, 1334 KB  
Article
Early Hematoma Evacuation Can Prevent Infectious Complications in Patients with Spontaneous Intracerebral Hemorrhage
by Daina Kashiwazaki, Kunitaka Maruyama, Shusuke Yamamoto, Emiko Hori, Kyo Noguchi and Satoshi Kuroda
J. Clin. Med. 2025, 14(18), 6480; https://doi.org/10.3390/jcm14186480 - 14 Sep 2025
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Abstract
Background/Objectives: Infections are common complications in patients with spontaneous intracerebral hemorrhage (ICH). This study investigated whether early surgical hematoma evacuation can reduce post-ICH infections and the impact of residual hematomas on infectious complications. Methods: Demographic, radiological, and clinical outcome data were collected for [...] Read more.
Background/Objectives: Infections are common complications in patients with spontaneous intracerebral hemorrhage (ICH). This study investigated whether early surgical hematoma evacuation can reduce post-ICH infections and the impact of residual hematomas on infectious complications. Methods: Demographic, radiological, and clinical outcome data were collected for 174 patients with spontaneous ICH. The patients were classified according to treatment (Group A, without surgery; Group B, hematoma evacuation with residual hematoma volume ≥10 mL; Group C, hematoma evacuation with residual hematoma volume <10 mL). Kaplan–Meier analysis was used to evaluate infectious complications following ICH, while multivariate logistic regression analysis was used to identify risk factors for infectious complications. Results: Groups A, B, and C included 88 (50.6%), 25 (14.4%), and 61 (35.0%) patients, respectively. A total of 68 patients (39.0%) experienced 88 infectious complications, most frequently pneumonia and urinary tract infections. Group C had a significantly lower frequency of infectious complications compared with Groups A and B (p = 0.016). The independent risk factors for infectious complications included age, higher National Institutes of Health Stroke Scale score at admission, motor weakness, intraventricular hemorrhage, Group A, and Group B. Patients with infections had longer hospital stays. The frequencies of poor clinical outcomes at one and six months in patients with infection were lower than those in patients without infection (both p < 0.01). Conclusions: Surgical hematoma evacuation can reduce the risk of post-hemorrhagic stroke infections. Moreover, residual hematoma after surgical evacuation was associated with the risk of cytotoxic effects and subsequent infectious complications. Full article
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