Ischemic lesions, blood pressure dysregulation, and poor outcomes in intracerebral hemorrhage
AuthorKidwell, Chelsea S.
Worrall, Bradford B.
James, Michael L.
Elkind, Mitchell S.V.
Flaherty, Matthew L.
Langefeld, Carl D.
Moomaw, Charles J.
AffiliationUniv Arizona, Dept Med Imaging
MetadataShow full item record
PublisherLIPPINCOTT WILLIAMS & WILKINS
CitationIschemic lesions, blood pressure dysregulation, and poor outcomes in intracerebral hemorrhage 2017, 88 (8):782 Neurology
Rights© 2017 American Academy of Neurology
Collection InformationThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at firstname.lastname@example.org.
AbstractObjective: 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). Methods: The Ethnic/ Racial Variations of Intracerebral Hemorrhage (ERICH) study is a multicenter, observational study of ICH among white, black, and Hispanic patients. Results: Of 600 patients, mean (6SD) age was 60.8 6 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 5 0.006). A logistic regression model of variables associated with DWI lesions included lower age (odds ratio [ OR] 0.721, p 5 0.002), higher first recorded systolic BP (10- unit OR 1.12, p 5 0.002), greater change in mean arterial pressure (MAP) prior to the MRI (10- unit OR 1.10, p 5 0.037), microbleeds (OR 1.99, p 5 0.008), and higher white matter hyperintensity (WMH) score (1- unit OR 1.16, p 5 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 5 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. 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. Neurology r 2017; 88: 782- 788
VersionFinal published version
SponsorsNational Institute of Neurological Disorders and Stroke [U-01-NS069763]
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- Issue date: 2015 Jun
- Effect of Hyperosmolar Therapy on Outcome Following Spontaneous Intracerebral Hemorrhage: Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) Study.
- Authors: Shah M, Birnbaum L, Rasmussen J, Sekar P, Moomaw CJ, Osborne J, Vashkevich A, Woo D
- Issue date: 2018 Apr
- Predictors of highly prevalent brain ischemia in intracerebral hemorrhage.
- Authors: Menon RS, Burgess RE, Wing JJ, Gibbons MC, Shara NM, Fernandez S, Jayam-Trouth A, German L, Sobotka I, Edwards D, Kidwell CS
- Issue date: 2012 Feb
- Racial-ethnic disparities in acute blood pressure after intracerebral hemorrhage.
- Authors: Koch S, Elkind MS, Testai FD, Brown WM, Martini S, Sheth KN, Chong JY, Osborne J, Moomaw CJ, Langefeld CD, Sacco RL, Woo D, ERICH Study Investigators.
- Issue date: 2016 Aug 23