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

Rajeev K Garg1, Storm M Liebling, Matthew B Maas

  • 1Northwestern University, Chicago, IL 60611, USA.

Stroke
|October 8, 2011
PubMed
Abstract

Insights

Decreased diffusion (DD) after intracerebral hemorrhage (ICH) is common and linked to lower blood pressure and worse outcomes. Preventing cerebral ischemia may improve patient survival and functional recovery.

Area of Science:

  • Neuroimaging
  • Neurology
  • Radiology

Background:

  • Decreased diffusion (DD) on MRI after acute intracerebral hemorrhage (ICH) is a recognized phenomenon.
  • Risk factors and impact of DD on functional outcomes post-ICH are not fully understood.

Purpose of the Study:

  • To investigate the relationship between acute blood pressure (BP) reduction, hemoglobin levels, and the occurrence of DD after ICH.
  • To determine if DD predicts worse functional outcomes at 14 days and 3 months post-ICH.

Main Methods:

  • Prospective evaluation of patients undergoing MRI after ICH.
  • Neuroradiologists assessed for DD, blinded to clinical outcomes.
  • Logistic regression analysis used to determine predictors of dependence or death (modified Rankin Scale 4-6).

Main Results:

  • DD was detected in 41% of patients (39/95).
  • DD was significantly associated with greater acute BP reductions and increased risk of death or dependence at 3 months (OR 4.8, P=0.004).
  • Lower hemoglobin correlated with worse ICH score and outcomes, but not with DD.

Conclusions:

  • DD is a frequent finding after ICH, associated with significant acute BP reduction.
  • DD predicts disability and mortality at 3 months, independent of ICH score.
  • Targeting cerebral ischemia, indicated by DD, may offer a strategy to improve outcomes after ICH.

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