Molecular Signatures of Course and Prognosis of Intracerebral Hemorrhage

Intracerebral hemorrhage (ICH) and some of its associated features are accompanied by increased levels of certain biochemical markers in serum. The amount of peri-hematoma edema formation is correlated with serum levels of glutamate, interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and intercellular adhesion molecule-1 (ICAM-1). In addition, serum glutamate levels are associated with poor neurological outcome. The matrix metalloproteinases (MMPs) are elevated in serum in patients with ICH. The MMP-9 isoform is also correlated with the initial volume of peri-hematoma edema, its subsequent enlargement in the first 48 hours from ICH onset, and neurological worsening. Hematoma enlargement after ICH onset is correlated with high serum levels of IL-6, TNF-α, MMP-9, and cellular fibronectin (c-Fn). The risk of hemorrhagic complications after acute ischemic stroke treated with t-PA thrombolysis is increased in subjects with elevated baseline serum levels of MMP-9. The above observations suggest that the determination of a number of serum markers may become an important tool for the prediction of ICH outcome, as well as for the assessment of risk of bleeding after thrombolysis for acute ischemic stroke.