Affiliation:
1. From the Departments of Neurology (K.R.W., Y.H., R.E.M., J.P.B., T.G.B.) and Pathology and Laboratory Medicine (G.X., G.M. de C.-M.), University of Cincinnati College of Medicine, and Medical Research Service (K.R.W., M.K., R.E.M.), Department of Veterans Affairs Medical Center, Cincinnati, Ohio.
Abstract
Background and Purpose
The mechanisms underlying brain injury from intracerebral hemorrhage (ICH) are complex and poorly understood. To comprehensively examine pathophysiological and pathochemical alterations after ICH and to examine the effects of hematoma removal on these processes, we developed a physiologically controlled, reproducible, large-animal model of ICH in pigs (weight, 6 to 8 kg).
Methods
We produced lobar hematomas by pressure-controlled infusions of 1.7 mL of autologous blood into the right frontal hemispheric white matter over 15 minutes. We froze brains in situ at 1, 3, 5, and 8 hours after hematoma induction and cut coronal sections for hematoma assessment, morphological brain examination, and immunohistochemical and water content determinations.
Results
At 1 hour after blood infusion, “translucent” white matter areas were present directly adjacent to the hematoma. These markedly edematous regions had a greater than 10% increase in water content (>85%) compared with the contralateral white matter (73%), and this increased water content persisted through 8 hours. In addition, these areas were strongly immunoreactive for serum proteins. Intravascular Evans blue dye failed to penetrate into the brain tissue at all time points, demonstrating that this serum protein accumulation and edema development were not due to increased blood-brain barrier permeability.
Conclusions
Experimental lobar ICH in pigs models a prominent pathological feature of human ICH, ie, early perihematomal edema. Our findings suggest that serum proteins, originating from the hematoma, accumulate in adjacent white matter and result in rapid and prolonged edema after ICH. This interstitial edema likely corresponds to the low densities on CT scans and the hyperintensities on T
2
-weighted MR images that surround intracerebral hematomas acutely after human ICH.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Advanced and Specialised Nursing,Cardiology and Cardiovascular Medicine,Clinical Neurology
Cited by
280 articles.
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