Association Between Haptoglobin Genotype and Brain Swelling
Association Between Haptoglobin Genotype and Brain Swelling
Intracerebral hemorrhage is bleeding into the brain and is a major cause of stroke and other
 complications. Brain injury from intracerebral hemorrhage occurs in two phases. The early
 phase involves the mechanical compression of brain tissue by the expanding hematoma. In a
 later phase, brain swelling develops causing further compression that may lead to brain
 herniation and death. This study investigates the neuroprotective role of haptoglobin, in
 minimizing the development of brain swelling following intracerebral hemorrhage.
Intracerebral hemorrhage is bleeding into the brain parenchyma. It is a major cause of
 stroke, and is associated with significant morbidity and mortality. Brain injury from
 intracerebral hemorrhage occurs in two phases. The early phase involves the mechanical
 compression of brain tissue by the expanding hematoma. In a later phase, brain edema,
 especially perihematomal edema, develops causing further compression that may lead to brain
 herniation and death. Several factors are implicated in the development of brain edema,
 including inflammation resulting from the oxidative stress caused by iron-rich hemoglobin
 released from lysed erythrocytes in brain tissue. This study investigates the neuroprotective
 role of an acute phase reactant, haptoglobin, in minimizing the development of perihematomal
 edema following intracerebral hemorrhage. This protein protects brain tissue from hemoglobin
 degradation products by forming haptoglobin-hemoglobin complexes that are subsequently
 cleared by the spleen. Notably, different alleles of haptoglobin exist in humans, with
 varying affinities for hemoglobin. Investigating the association between the different
 alleles and the degree of perihematomal edema formation is the primary goal of this study.
 The investigators will also look at a marker of inflammation, matrix metalloproteinases, and
 analyze its level of expression in subjects with different alleles of haptoglobin.
Inclusion Criteria:

 -  Spontaneous intracranial or intraparenchymal hemorrhage

 -  18-85 years of age

 -  Hemorrhage occurred in a supratentorial location

 Exclusion Criteria:

 -  Inability to obtain consent within 3 days of hemorrhage onset

 -  Known pregnancy

 -  Therapeutic anticoagulation with Lovenox, Coumadin or Heparin

 -  Prior history of therapeutic radiation to any area

 -  Brain tumor

 -  Hemorrhage related to trauma, aneurysm, arteriovenous malformation or other vascular
 malformation

 -  Central nervous system infection

 -  Subdural hematoma

 -  Subarachnoid hemorrhage

 -  Chronic immunosuppression, including steroids or chemotherapy agents

 -  Infratentorial location

 -  Unable to obtain MRI due to mental status or other contraindication (metal, pacemaker,
 etc.)