Predictors of highly prevalent brain ischemia in intracerebral hemorrhage

Ann Neurol. 2012 Feb;71(2):199-205. doi: 10.1002/ana.22668.

Abstract

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).

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.

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).

Interpretation: This study demonstrates that >⅓ of patients with primary ICH have active cerebral ischemia at baseline remote from the index hematoma, and ¼ 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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Acute Disease
  • African Continental Ancestry Group
  • Aged
  • Brain Ischemia / complications
  • Brain Ischemia / epidemiology*
  • Brain Ischemia / physiopathology*
  • Cerebral Hemorrhage / complications
  • Cerebral Hemorrhage / epidemiology*
  • Cerebral Hemorrhage / physiopathology*
  • 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