Intranasal Drug Delivery After Intracerebral Hemorrhage

Intracerebral hemorrhage (ICH) accounts for 10–15% of strokes and is associated with high mortality and disability rates. Studies in animal models suggest a complex pathophysiology mediated by multiple injury cascades that are initiated in the hours after hemorrhage. Effective neuroprotection will therefore likely require rapid delivery of a combination of therapies to perihematomal tissue at risk while minimizing adverse systemic effects. These aims are unlikely to be accomplished by exclusive reliance on intravenous drug administration due to delays in blood-brain barrier penetration and the additive toxicities of multiple agents. In the prehospital and emergency department settings, intranasal drug delivery is the only method currently available that may offer any selective brain targeting. Intranasal administration of recombinant proteins, small molecules and mesenchymal stem cells has improved outcome in both collagenase and blood injection ICH models. These results and the potential utility of intranasal therapies after ICH are reviewed and discussed in this chapter.