**Author details**

Less clear is the existence of gender differences in pathophysiology and outcomes after ICH.

While preclinical data support the role of gonadal hormones influencing hemostatic and

neuroinflammatory modulation after ICH, their effects on recovery in humans are unknown.

1 Tanaka (1981) [23 ] Shibata, Japan 1976-1978 Higher incidence of ICH in men

<sup>2</sup> Bamford (1988) [9,51] Oxford shire, UK 1981-86 Same incidence of ICH across genders.

<sup>6</sup> Lauria G (1995) [13] Italy <sup>1992</sup> Slightly higher incidence of ICH in

<sup>8</sup> Kolominsky-Rabas (1998) [17] Germany 1993-1995 Slightly higher incidence of ICH in

<sup>9</sup> Sacco (1998) [26] New York, USA 1993-1996 Higher incidence of ICH in men but

<sup>10</sup> Vemmos (1999) [16] Greece 1993-1995 Much higher incidence of ICH in older

13 Di Carlo (2003) [14] Calabria, Italy 1996 Slightly higher incidence of ICH in men

<sup>15</sup> Kubo (2003) [18] Japan 1961-2000 Significantly higher incidence of ICH in

<sup>16</sup> Zhang (2003) [24] China 1991- 2000 No difference in mortality in ICH across

17 Sivenius (2004) [8] Finland 1983-1997 Higher incidence of ICH in men

<sup>11</sup> Morikawa (2000) [19] Rural Japan 1977-1991 Same incidence and age of

<sup>7</sup> Kimura (1998) [41] Okinawa, Japan 1988-1991 No difference in ICH related mortality

Women older age of presentation

No difference in incidence of ICH

No difference in incidence of ICH

No difference in incidence of ICH across genders, women older age of

at day 30 across genders

women older at age of presentation

presentation of ICH across genders

Incidence of ICH more in men as

Incidence of ICH more in men as

compared to women

compared to women

across genders

across genders

presentation

women

women

men

men

genders

**No. Author Study details Year/s Observations**

3 Giroud (1991) [10] Dijon, France 1985-1989

5 Fogelholm (1992) [11] Central Finland 1985-1989

12 Thrift (2001) [30] Australia 1996-1997

14 Inagawa (2003) [20] Izumo, Japan 1991-1998

4 D'Alessandro (1992) [12] Italy 1989

18 Intracerebral Hemorrhage

Michael James1\* and Sankalp Gokhale2

\*Address all correspondence to: Michael.james@duke.edu

1 Department of Neurology and Anesthesiology, Duke University Hospital, Duke University School of Medicine, NC, USA

2 Department of Neurology, Duke University Hospital, Duke University School of Medicine, NC, USA

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22 Intracerebral Hemorrhage


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**Chapter 3**

**The Pathogenesis of Edema**

Gaiqing Wang

**1. Introduction**

**2. Body**

http://dx.doi.org/10.5772/58542

directly by drug therapies [1-2].

**and Secondary Insults after ICH**

Additional information is available at the end of the chapter

hematoma and subsequent degradation byproducts [3].

Intracerebral hemorrhage (ICH) is a type of acute stroke characterized by extravasation of blood into brain parenchyma and formation of hematoma, leading to edema and tissue damage in the brain. During ICH, rapid accumulation of blood within brain parenchyma leads to disruption of normal anatomy and increased local pressure. Depending on the dynamic of hematoma expansion (growth), the primary damage occurs within minutes to hours from the onset of bleeding and is primarily the result of mechanical damage associated with the mass effect, which compress adjacent tissues, thus destroying them. The 'mass effect' is an important factor in the pathogenic events in ICH. But it may be difficult to predict and manage this effect

Once present, ICH causes both primary and secondary injury. The primary insult is due to disruption of adjacent tissue and mass effect. Secondary injury occurs with the development of edema, free radical formation, inflammation, and direct cellular toxicity due to the deposited

After arteriolar rupture and parenchymal hemorrhage in the brain, a combination of local compression, cytotoxic injury, inflammation, and surrounding edema ensues. Many patients with ICH deteriorate progressively with no sign of hematoma expansion, suggesting that secondary damage following ICH plays a critical role in neurological deterioration. Secondary damage is, for the most part, attributable to the presence of intraparenchymal blood and may be dependent on the initial hematoma volume, patients age, or ventricu‐

> © 2014 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

