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Intracranial Hemorrhage: Treatment and Rehabilitation
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Intracranial Hemorrhage: Treatment and Rehabilitation

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

Deadline for manuscript submissions: closed (20 October 2024) | Viewed by 12702

Special Issue Editors

Dr. Frieder Schlunk

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Guest Editor
Department of Neuroradiology, Universitätsklinikum Freiburg, 79106 Freiburg, Germany
Interests: intracerebral hemorrhage; hematoma expansion; CT; stroke
Dr. Jawed Nawabi

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Guest Editor
1. Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, 10117 Berlin, Germany
2. Berlin Institute of Health (BIH), BIH Biomedical Innovation Academy, Berlin, Germany
Interests: ischemic stroke; hemorrhagic stroke; outcome prediction; diagnosis prediction; quantitative-imaging-based models for prediction; computed tomography imaging-based radiomic models; deep learning in the imaging study of stroke
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Intracranial hemorrhage has life-threatening and life-changing consequences. Acute management primarily focuses on stopping the bleeding and reducing the elevated intracranial pressure. Advances, especially in the fields of interventional neuroradiology and neurosurgery, have led to more precise and effective techniques (for example, the coiling or clipping of cerebral aneurysms), offering improved prognoses for patients. In other subtypes of intracranial hemorrhage, such as intracerebral hemorrhage, large randomized clinical trials have been published, but an effective therapy with which to limit hematoma expansion has still not been convincingly demonstrated.

Following an acute phase in a hospital, patient rehabilitation begins to assist affected patients in regaining their functions and abilities. Comprehensive rehabilitation encompasses various aspects, including physical therapy, speech therapy, occupational therapy, and psychosocial support.

This Special Issue aims at presenting recent advances in the treatment and rehabilitation of the different subtypes of intracranial hemorrhage, and we welcome authors to submit their works.

Dr. Frieder Schlunk
Dr. Jawed Nawabi
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • intracranial hemorrhage
  • management
  • rehabilitation
  • physical therapy
  • speech therapy
  • occupational therapy
  • psychosocial support

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Published Papers (5 papers)

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Research

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11 pages, 1090 KiB  
Article
Brain Atrophy Is Associated with Hematoma Expansion in Intracerebral Hemorrhage, Depending on Coagulation Status
by Anna Speth, Andrea Dell’Orco, Justus F. Kleine, Christopher Güttler, Andrea Morotti, Horst Urbach, Georg Bohner, Michael Scheel, Jawed Nawabi and Frieder Schlunk
J. Clin. Med. 2025, 14(7), 2227; https://doi.org/10.3390/jcm14072227 - 25 Mar 2025
Viewed by 279
Abstract
Background/Objectives: This study aimed to research the potential association between brain atrophy and hematoma expansion (HE) in intracerebral hemorrhage (ICH). Methods: A retrospective analysis was conducted using data from patients with primary ICH in our stroke database. ICH volumes from initial and follow-up [...] Read more.
Background/Objectives: This study aimed to research the potential association between brain atrophy and hematoma expansion (HE) in intracerebral hemorrhage (ICH). Methods: A retrospective analysis was conducted using data from patients with primary ICH in our stroke database. ICH volumes from initial and follow-up CT scans were manually segmented. Total brain and intracranial volumes were quantified using an automated head CT segmentation method. Normalized brain volume (NBV) was calculated by dividing the total brain volume by the total intracranial volume to account for individual head size differences. The relationship between the NBV and hematoma expansion was assessed using linear regression, adjusting for other variables influencing hematoma expansion. Results: Our final analysis included 420 patients. Brain atrophy (lower NBV) was associated with hematoma growth (>0 mL) in patients not on oral anticoagulants (β = −0.159, p = 0.032). A strong association was observed in patients using vitamin K antagonists (β = −0.667, p = 0.006) but not in those on direct oral anticoagulants (DOACs; (β = −0.159, p = 0.436)). Results remained significant in patients not on oral anticoagulants and in those on VKAs when hematoma expansion was defined as a volume increase >6 mL or >33%. Conclusions: This research provides initial evidence that brain atrophy is a risk factor for hematoma expansion, depending on the patient’s coagulation status. These findings could enhance risk stratification for acute clinical management and deepen understanding of the biological mechanisms behind hematoma expansion. Full article
(This article belongs to the Special Issue Intracranial Hemorrhage: Treatment and Rehabilitation)
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Review

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13 pages, 235 KiB  
Review
Non-Invasive Brain Stimulation to Improve Functional Recovery and Predict Outcome After Intracerebral Hemorrhage: A Narrative Review
by Daniele Zanola, Andrea Morotti and Alessandro Padovani
J. Clin. Med. 2025, 14(2), 398; https://doi.org/10.3390/jcm14020398 - 10 Jan 2025
Viewed by 1013
Abstract
Intracerebral hemorrhage (ICH) is a leading cause of stroke-related mortality and long-term disability, with initial ICH volume, age, location of the hemorrhage, and clinical severity being key predictors of outcome. While clinical scores incorporating these elements are validated and exhibit good inter-rater reliability, [...] Read more.
Intracerebral hemorrhage (ICH) is a leading cause of stroke-related mortality and long-term disability, with initial ICH volume, age, location of the hemorrhage, and clinical severity being key predictors of outcome. While clinical scores incorporating these elements are validated and exhibit good inter-rater reliability, their accuracy in predicting long-term recovery remains suboptimal. Non-invasive brain stimulation (NIBS) has emerged as a potential adjunct for improving both prognostication and functional recovery in ICH survivors. Despite promising results, heterogeneity in stimulation protocols, patients’ populations, and outcome measures have prevented NIBS implementation in clinical practice. This narrative review summarizes the available evidence on the association between NIBS, outcome prediction and functional recovery, discussing current challenges and future perspectives. Full article
(This article belongs to the Special Issue Intracranial Hemorrhage: Treatment and Rehabilitation)
19 pages, 1082 KiB  
Review
Facilitating Corticomotor Excitability of the Contralesional Hemisphere Using Non-Invasive Brain Stimulation to Improve Upper Limb Motor Recovery from Stroke—A Scoping Review
by Pui Kit Tam, Nicodemus Edrick Oey, Ning Tang, Guhan Ramamurthy and Effie Chew
J. Clin. Med. 2024, 13(15), 4420; https://doi.org/10.3390/jcm13154420 - 28 Jul 2024
Cited by 1 | Viewed by 1874
Abstract
Upper limb weakness following stroke poses a significant global psychosocial and economic burden. Non-invasive brain stimulation (NIBS) is a potential adjunctive treatment in rehabilitation. However, traditional approaches to rebalance interhemispheric inhibition may not be effective for all patients. The supportive role of the [...] Read more.
Upper limb weakness following stroke poses a significant global psychosocial and economic burden. Non-invasive brain stimulation (NIBS) is a potential adjunctive treatment in rehabilitation. However, traditional approaches to rebalance interhemispheric inhibition may not be effective for all patients. The supportive role of the contralesional hemisphere in recovery of upper limb motor function has been supported by animal and clinical studies, particularly for those with severe strokes. This review aims to provide an overview of the facilitation role of the contralesional hemisphere for post-stroke motor recovery. While more studies are required to predict responses and inform the choice of NIBS approach, contralesional facilitation may offer new hope for patients in whom traditional rehabilitation and NIBS approaches have failed. Full article
(This article belongs to the Special Issue Intracranial Hemorrhage: Treatment and Rehabilitation)
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22 pages, 8196 KiB  
Review
Spontaneous Non-Aneurysmal Convexity Subarachnoid Hemorrhage: A Scoping Review of Different Etiologies beyond Cerebral Amyloid Angiopathy
by Marialuisa Zedde, Ilaria Grisendi, Federica Assenza, Manuela Napoli, Claudio Moratti, Claudio Pavone, Lara Bonacini, Giovanna Di Cecco, Serena D’Aniello, Francesca Romana Pezzella, Giovanni Merlino, Fabrizio Piazza, Alessandro Pezzini, Andrea Morotti, Enrico Fainardi, Danilo Toni, Franco Valzania and Rosario Pascarella
J. Clin. Med. 2024, 13(15), 4382; https://doi.org/10.3390/jcm13154382 - 26 Jul 2024
Cited by 2 | Viewed by 1862
Abstract
Spontaneous convexity subarachnoid hemorrhage (cSAH) is a vascular disease different from aneurysmal SAH in neuroimaging pattern, causes, and prognosis. Several causes might be considered in individual patients, with a limited value of the patient’s age for discriminating among these causes. Cerebral amyloid angiopathy [...] Read more.
Spontaneous convexity subarachnoid hemorrhage (cSAH) is a vascular disease different from aneurysmal SAH in neuroimaging pattern, causes, and prognosis. Several causes might be considered in individual patients, with a limited value of the patient’s age for discriminating among these causes. Cerebral amyloid angiopathy (CAA) is the most prevalent cause in people > 60 years, but reversible cerebral vasoconstriction syndrome (RCVS) has to be considered in young people. CAA gained attention in the last years, but the most known manifestation of cSAH in this context is constituted by transient focal neurological episodes (TFNEs). CAA might have an inflammatory side (CAA-related inflammation), whose diagnosis is relevant due to the efficacy of immunosuppression in resolving essudation. Other causes are hemodynamic stenosis or occlusion in extracranial and intracranial arteries, infective endocarditis (with or without intracranial infectious aneurysms), primary central nervous system angiitis, cerebral venous thrombosis, and rarer diseases. The diagnostic work-up is fundamental for an etiological diagnosis and includes neuroimaging techniques, nuclear medicine techniques, and lumbar puncture. The correct diagnosis is the first step for choosing the most effective and appropriate treatment. Full article
(This article belongs to the Special Issue Intracranial Hemorrhage: Treatment and Rehabilitation)
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15 pages, 1490 KiB  
Review
Intracranial Hemorrhage—Is Very Early Rehabilitation Safe? A Narrative Review
by Klaudia Marek, Ewa Zielińska-Nowak, Justyna Redlicka, Michał Starosta and Elżbieta Miller
J. Clin. Med. 2024, 13(13), 3776; https://doi.org/10.3390/jcm13133776 - 27 Jun 2024
Cited by 2 | Viewed by 6249
Abstract
Intracerebral hemorrhage (ICH) is a serious neurological disease with a 30-day mortality rate of 34–50%. Rehabilitation can reduce disability and improve recovery from a stroke; however, it is uncertain whether early rehabilitation is safe. There are many studies and reviews on rehabilitation for [...] Read more.
Intracerebral hemorrhage (ICH) is a serious neurological disease with a 30-day mortality rate of 34–50%. Rehabilitation can reduce disability and improve recovery from a stroke; however, it is uncertain whether early rehabilitation is safe. There are many studies and reviews on rehabilitation for chronic conditions, but there is not enough information on the details of rehabilitation in the acute and subacute phases of ICH. We analyzed clinical trials from the electronic databases PubMed, PubMedCentral, Medline, Cochrane Library, Embase, Scopus and PEDro. Based on the data, we determined that early rehabilitation of patients with ICH has beneficial effects on improving ADL scores, motor function, functional independence, quality of life, improved gait, improved trunk control and reduced mortality. Varying the duration and intensity of rehabilitation in patients with ICH may improve health status, functional outcomes and reduce the length of stay in the hospital. The earliest protocol for initiating rehabilitation after ICH included up to 24 h after stroke onset. The medical literature indicates the need for more randomized controlled group trials of early rehabilitation in patients with acute and subacute ICH with a precise timing of rehabilitation initiation. This narrative review aims to summarize the existing evidence and provide insights into the current state of knowledge regarding the safety of early rehabilitation. There is a need for a clear definition of “early rehabilitation” when determining the most appropriate time to begin rehabilitation therapy. Full article
(This article belongs to the Special Issue Intracranial Hemorrhage: Treatment and Rehabilitation)
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