Inflammation, edema, hematoma and etiology - a rectangular relationship?

Volbers, Bastian; Fischer, Urs; Huttner, H. B. (2019). Inflammation, edema, hematoma and etiology - a rectangular relationship? European journal of neurology, 26(1), e11-e11. Wiley 10.1111/ene.13829

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It was with great interest that we read the publication by Iglesias-Rey et al. [1], who found an association of elevated body temperature with perihemorrhagic edema (PHE) evolution exclusively in hypertension-related intracerebral hemorrhage (ICH). In accordance with pathophysiologic findings, others found an independent association of PHE evolution with inflammatory parameters including fever in ICH without further etiological differentiation [2,3]. Etiological classification of ICH may be challenging. Classifying patients with
several identified etiological factors as unknown may pose possible bias. Identifying cerebral amyloid angiopathy (CAA)related ICH may require specific criteria and possibly further diagnostic testing [4,5]. A detailed description would be helpful. Furthermore, a larger sample size may be necessary to detect mechanisms related to PHE evolution in subgroups of ICH patients (e.g. CAA-related) due to the complex pathophysiological processes associated with PHE [2,3,6]. Here, ICH volume in particular and related measures are considered to be a major factor contributing to PHE evolution [6,7]. Thus, it is important to adjust analyses correlating PHE with other variables for ICH volume to assess independent associations. Delineation of PHE may be difficult on computed tomography scans. Although volumetric assessments using the ABC/2 formula may be considered when analysing hematoma volumes [8], validated algorithms are recommended in PHE assessment [9,10]. Although increasing evidence supports the association of inflammation and temperature with PHE evolution, further research is required to elucidate the complex interaction between inflammation, edema, hematoma and etiology.

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