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. 2012 Jan;43(1):67-71.
doi: 10.1161/STROKEAHA.111.629493. Epub 2011 Oct 6.

Blood pressure reduction, decreased diffusion on MRI, and outcomes after intracerebral hemorrhage

Rajeev K Garg  1 , Storm M Liebling, Matthew B Maas, Alexander J Nemeth, Eric J Russell, Andrew M Naidech
Affiliations

Blood pressure reduction, decreased diffusion on MRI, and outcomes after intracerebral hemorrhage

Rajeev K Garg et al. Stroke. 2012 Jan.

Abstract

Background and purpose: Decreased diffusion (DD) consistent with acute ischemia may be detected on MRI after acute intracerebral hemorrhage (ICH), but its risk factors and impact on functional outcomes are not well-defined. We tested the hypotheses that DD after ICH is related to acute blood pressure (BP) reduction and lower hemoglobin and presages worse functional outcomes.

Methods: Patients who underwent MRI were prospectively evaluated for DD by certified neuroradiologists blinded to outcomes. Hemoglobin and BP data were obtained via electronic queries. Outcomes were obtained at 14 days and 3 months with the modified Rankin Scale, a functional scale scored from 0 (no symptoms) to 6 (dead). We used logistic regression for dependence or death (modified Rankin Scale score 4-6).

Results: DD distinct from the hematoma was found on MRI in 39 of 95 patients (41%). DD was associated with greater BP reductions from baseline and a higher risk of dependence or death at 3 months (odds ratio, 4.8; 95% confidence interval, 1.7-13.9; P=0.004) after correction for ICH score (1.8 per point; 95% confidence interval, 1.2-3.1; P=0.01). Lower hemoglobin was associated with worse ICH score, larger hematoma volume, and worse outcomes, but not DD.

Conclusions: DD is common after ICH, associated with greater acute BP reductions, and associated with disability and death at 3 months in multivariate analysis. The potential benefits of acute BP reduction to reduce hematoma growth may be limited by DD. The prevention and treatment of cerebral ischemia manifested as DD are potential methods to improve outcomes.

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Conflict of interest statement

Conflict of Interest Disclosure

AMN has received research funding from Gaymar, Inc and Astellas Pharma US, unrelated to this topic, and serves as a medical safety monitor for two unrelated NIH funded studies. After the first submission, RKG was notified of an award from American Heart Association to perform prospective research on this topic.

The other authors declare they have no conflicts.

Figures

Figure
Figure
Change in systolic (a) and diastolic (b) BP (vertical axis) every four hours (horizontal axis) from ICH symptom onset, stratified by the presence (dashed line) or absence (solid line) of decreased diffusion. Patients with decreased diffusion had greater reductions in BP from baseline.
Figure
Figure
Change in systolic (a) and diastolic (b) BP (vertical axis) every four hours (horizontal axis) from ICH symptom onset, stratified by the presence (dashed line) or absence (solid line) of decreased diffusion. Patients with decreased diffusion had greater reductions in BP from baseline.
See this image and copyright information in PMC

Comment in

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