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Comparative Study
. 2011 Nov 8;77(19):1725-8.
doi: 10.1212/WNL.0b013e318236ef46. Epub 2011 Oct 26.

Hyperacute injury marker (HARM) in primary hemorrhage: a distinct form of CNS barrier disruption

C S Kidwell  1 , R Burgess, R Menon, S Warach, L L Latour
Affiliations
Comparative Study

Hyperacute injury marker (HARM) in primary hemorrhage: a distinct form of CNS barrier disruption

C S Kidwell et al. Neurology. .

Abstract

Objective: The objective of the study was to characterize a previously unreported form of CNS barrier disruption in intracerebral hemorrhage (ICH): hyperacute injury marker (HARM).

Methods: In this retrospective cohort analysis of patients presenting with primary ICH, precontrast and postcontrast MRI scans obtained within 5 days of symptom onset were analyzed. The presence of CNS barrier disruption was defined by (1) perihematomal or intrahematomal enhancement visualized on postcontrast T1-weighted MRI or (2) HARM: sulcal or ventricular hyperintensity visualized on postcontrast fluid-attenuated inversion recovery sequences (graded on a 5-point scale).

Results: Forty-six patients were included in the analysis. Mean age was 65 years, median NIH Stroke Scale score was 7, and mean ICH volume was 12.2 mL (range 0.3-46.9 mL). HARM was visualized in 85% of patients, and this was moderate to severe in 50%. In all cases, the sulcal enhancement was noncontiguous with the hematoma. Of those patients with postcontrast T1-weighted imaging, perihematomal or intrahematomal contrast enhancement was visualized in 75% of patients.

Conclusions: This study demonstrates that HARM occurs in intracerebral hemorrhage and that it likely represents a second type of CNS barrier disruption distinct from parenchymal postcontrast T1-weighted enhancement. Similar to T1 enhancement, this phenomenon may serve as a clinically useful biomarker to test therapies aimed at stabilizing acute ICH and CNS barrier disruption. Future studies are needed to further define the time course and prognostic implications of this finding.

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Figures

Figure 1
Figure 1. Frequency of hyperacute injury marker (HARM) by severity across subjects
Dark gray represents the proportion of patients with less than 12 hours between last known well time and MRI, while light gray represents the proportion of patients scanned beyond 12 hours from symptom onset.
Figure 2
Figure 2. Example of development of multipunctate contrast enhancement
(A) Right frontal lobar hematoma. (B) Precontrast fluid-attenuated inversion recovery (FLAIR) sequence. (C) Interval development of punctuate regions of contrast enhancement in the sulci bilaterally (arrows). GRE = gradient echo.
See this image and copyright information in PMC

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