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Ischemic lesions, blood pressure dysregulation, and poor outcomes in intracerebral hemorrhage.
- Source :
-
Neurology [Neurology] 2017 Feb 21; Vol. 88 (8), pp. 782-788. Date of Electronic Publication: 2017 Jan 25. - Publication Year :
- 2017
-
Abstract
- Objective: To evaluate the associations among diffusion-weighted imaging (DWI) lesions, blood pressure (BP) dysregulation, MRI markers of small vessel disease, and poor outcome in a large, prospective study of primary intracerebral hemorrhage (ICH).<br />Methods: The Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study is a multicenter, observational study of ICH among white, black, and Hispanic patients.<br />Results: Of 600 patients, mean (±SD) age was 60.8 ± 13.6 years, median (interquartile range) ICH volume was 9.1 mL (3.5-20.8), and 79.6% had hypertension. Overall, 26.5% of cases had DWI lesions, and this frequency differed by race/ethnicity (black 33.8%, Hispanic 24.9%, white 20.2%, overall p = 0.006). A logistic regression model of variables associated with DWI lesions included lower age (odds ratio [OR] 0.721, p = 0.002), higher first recorded systolic BP (10-unit OR 1.12, p = 0.002), greater change in mean arterial pressure (MAP) prior to the MRI (10-unit OR 1.10, p = 0.037), microbleeds (OR 1.99, p = 0.008), and higher white matter hyperintensity (WMH) score (1-unit OR 1.16, p = 0.002) after controlling for race/ethnicity, leukocyte count, and acute in-hospital antihypertensive treatment. A second model of variables associated with poor 90-day functional outcome (modified Rankin Scale scores 4-6) included DWI lesion count (OR 1.085, p = 0.034) as well as age, ICH volume, intraventricular hemorrhage, Glasgow Coma Scale score, WMH score, race/ethnicity, acute in-hospital antihypertensive treatment, and ICH location.<br />Conclusions: These results support the hypotheses that acute BP dysregulation is associated with the development of DWI lesions in primary ICH and that DWI lesions are, in turn, associated with poor outcomes.<br /> (© 2017 American Academy of Neurology.)
- Subjects :
- Blood Pressure Determination
Brain Ischemia ethnology
Brain Ischemia therapy
Case-Control Studies
Cerebral Hemorrhage ethnology
Cerebral Hemorrhage physiopathology
Diffusion Magnetic Resonance Imaging
Female
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Prospective Studies
Treatment Outcome
United States
Blood Pressure physiology
Brain diagnostic imaging
Brain Ischemia diagnostic imaging
Brain Ischemia physiopathology
Cerebral Hemorrhage diagnostic imaging
Cerebral Hemorrhage therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1526-632X
- Volume :
- 88
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Neurology
- Publication Type :
- Academic Journal
- Accession number :
- 28122903
- Full Text :
- https://doi.org/10.1212/WNL.0000000000003630