Predictors of highly prevalent brain ischemia in intracerebral hemorrhage.
Predictors of highly prevalent brain ischemia in intracerebral hemorrhage.
Available online from MWHC library: 1996 - present
INTERPRETATION: This study demonstrates that >1/3 of patients with primary ICH have active cerebral ischemia at baseline remote from the index hematoma, and 1/4 of patients experience ongoing, acute ischemic events at 1 month. Multivariate analyses implicate blood pressure reductions in the setting of an active vasculopathy as a potential underlying mechanism. Further studies are needed to determine the impact of these lesions on outcome and optimal management strategies to arrest vascular damage. Copyright 2012 American Neurological Association. METHODS: Patients were recruited within a prospective, longitudinal, magnetic resonance imaging (MRI)-based study of primary ICH. Clinical, demographic, and MRI data were collected on all subjects at baseline and 1 month. OBJECTIVE: This study was undertaken to determine the prevalence, characteristics, risk factors, and temporal profile of concurrent ischemic lesions in patients with acute primary intracerebral hemorrhage (ICH). RESULTS: Of the 138 patients enrolled, mean age was 59 years, 54% were male, 73% were black, and 84% had a history of hypertension. At baseline, ischemic lesions on diffusion-weighted imaging (DWI) were found in 35% of patients. At 1 month, lesions were present in 27%, and of these lesions, 83% were new and not present at baseline. ICH volume (p = 0.025), intraventricular hemorrhage (p = 0.019), presence of microbleeds (p = 0.024), and large, early reductions in mean arterial pressure (p = 0.003) were independent predictors of baseline DWI lesions. A multivariate logistical model predicting the presence of 1-month DWI lesions included history of any prior stroke (p = 0.012), presence of 1 or more microbleeds (p = 0.04), black race (p = 0.641), and presence of a DWI lesion at baseline (p = 0.007).
English
0364-5134
*Brain Ischemia/ep [Epidemiology]
*Brain Ischemia/pp [Physiopathology]
*Cerebral Hemorrhage/ep [Epidemiology]
*Cerebral Hemorrhage/pp [Physiopathology]
Acute Disease
African Continental Ancestry Group
Aged
Brain Ischemia/co [Complications]
Cerebral Hemorrhage/co [Complications]
Comorbidity
Diffusion Magnetic Resonance Imaging
Female
Humans
Male
Middle Aged
Predictive Value of Tests
Prevalence
Prospective Studies
Risk Factors
Severity of Illness Index
Time Factors
United States
MedStar Health Research Institute
MedStar Heart & Vascular Institute
MedStar Washington Hospital Center
Neurology
Journal Article
Research Support, N.I.H., Extramural
Available online from MWHC library: 1996 - present
INTERPRETATION: This study demonstrates that >1/3 of patients with primary ICH have active cerebral ischemia at baseline remote from the index hematoma, and 1/4 of patients experience ongoing, acute ischemic events at 1 month. Multivariate analyses implicate blood pressure reductions in the setting of an active vasculopathy as a potential underlying mechanism. Further studies are needed to determine the impact of these lesions on outcome and optimal management strategies to arrest vascular damage. Copyright 2012 American Neurological Association. METHODS: Patients were recruited within a prospective, longitudinal, magnetic resonance imaging (MRI)-based study of primary ICH. Clinical, demographic, and MRI data were collected on all subjects at baseline and 1 month. OBJECTIVE: This study was undertaken to determine the prevalence, characteristics, risk factors, and temporal profile of concurrent ischemic lesions in patients with acute primary intracerebral hemorrhage (ICH). RESULTS: Of the 138 patients enrolled, mean age was 59 years, 54% were male, 73% were black, and 84% had a history of hypertension. At baseline, ischemic lesions on diffusion-weighted imaging (DWI) were found in 35% of patients. At 1 month, lesions were present in 27%, and of these lesions, 83% were new and not present at baseline. ICH volume (p = 0.025), intraventricular hemorrhage (p = 0.019), presence of microbleeds (p = 0.024), and large, early reductions in mean arterial pressure (p = 0.003) were independent predictors of baseline DWI lesions. A multivariate logistical model predicting the presence of 1-month DWI lesions included history of any prior stroke (p = 0.012), presence of 1 or more microbleeds (p = 0.04), black race (p = 0.641), and presence of a DWI lesion at baseline (p = 0.007).
English
0364-5134
*Brain Ischemia/ep [Epidemiology]
*Brain Ischemia/pp [Physiopathology]
*Cerebral Hemorrhage/ep [Epidemiology]
*Cerebral Hemorrhage/pp [Physiopathology]
Acute Disease
African Continental Ancestry Group
Aged
Brain Ischemia/co [Complications]
Cerebral Hemorrhage/co [Complications]
Comorbidity
Diffusion Magnetic Resonance Imaging
Female
Humans
Male
Middle Aged
Predictive Value of Tests
Prevalence
Prospective Studies
Risk Factors
Severity of Illness Index
Time Factors
United States
MedStar Health Research Institute
MedStar Heart & Vascular Institute
MedStar Washington Hospital Center
Neurology
Journal Article
Research Support, N.I.H., Extramural