Predictors of highly prevalent brain ischemia in intracerebral hemorrhage.

MedStar author(s):
Citation: Annals of Neurology. 71(2):199-205, 2012 Feb.PMID: 22367992Institution: MedStar Health Research Institute | MedStar Heart & Vascular Institute | MedStar Washington Hospital CenterDepartment: NeurologyForm of publication: Journal ArticleMedline article type(s): Journal Article | Research Support, N.I.H., ExtramuralSubject headings: *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 StatesLocal holdings: Available online from MWHC library: 1996 - presentISSN:
  • 0364-5134
Name of journal: Annals of neurologyAbstract: 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).All authors: Burgess RE, Edwards D, Fernandez S, German L, Gibbons MC, Jayam-Trouth A, Kidwell CS, Menon RS, Shara NM, Sobotka I, Wing JJDigital Object Identifier: Date added to catalog: 2013-09-17
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article Available 22367992

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).

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