Narrative review proposes integrative monitoring framework for intracerebral hemorrhage

Although ferroptosis is well-established as a key driver of secondary brain injury following intracerebral hemorrhage (ICH), current monitoring strategies fail to capture its dynamic substrate-execution-amplification network. This failure stems from the susceptibility of single biomarkers to systemic inflammatory confounding and the lack of molecular sensitivity in conventional imaging, ultimately causing a profound disconnect between pathological monitoring and clinical intervention. In light of this, after critically evaluating existing limitations, this review proposes a mechanism-driven, multidimensional integrative monitoring framework: specifically, it aims to eliminate systemic confounding by combining iron metabolism with inflammatory indices (contextualization), track neuronal lipid peroxidation utilizing brain-derived exosomes and F4-neuroprostanes (specificity), and visualize iron deposition by integrating biofluid biomarkers with quantitative susceptibility mapping (spatial resolution). Such multimodal integration represents more than a mere refinement of diagnostic techniques; it is a prerequisite for achieving precision medicine in ICH. Serving as a critical companion diagnostic tool, this framework facilitates the stratification of patients responsive to iron chelation and anti-ferroptotic therapies, thereby propelling clinical management from empirical treatment toward mechanism-directed precision intervention.