Secondary decline of cerebral autoregulation is associated with worse outcome after intracerebral hemorrhage.
OBJECTIVE
Blood pressure management in acute intracerebral hemorrhage (ICH) relies on functioning cerebral autoregulation. The time course of autoregulation in acute ICH and its relation with clinical outcome are not known.


METHODS
Twenty-six patients with spontaneous ICH were studied on days 1, 3 and 5 after ictus. Autoregulation was noninvasively measured from spontaneous fluctuations of blood pressure and middle cerebral artery flow velocity (assessed by transcranial Doppler) using the correlation coefficient index Mx. From the same signals, non-invasive cerebral perfusion pressure was calculated. Results were compared with 55 healthy controls and related with clinical and radiological factors and 90-day outcome (modified Rankin scale).


RESULTS
Average Mx values of all patients did not differ across days or from controls. Higher Mx (i.e., poorer autoregulation) on day 5 was significantly related with lower Glasgow coma score, ventricular hemorrhage (both sides) and lower noninvasive cerebral perfusion pressure (ipsilateral). Increasing ipsilateral Mx between days 3 and 5 was related with lower Glasgow coma score and ventricular hemorrhage. In a multivariate analysis controlling for other hemodynamic factors, higher ipsilateral Mx on day 5 (p = 0.013) was a significant predictor for poor 90-day outcome.


CONCLUSIONS
Cerebral autoregulation is primarily preserved in acute ICH, but a secondary decline mainly ipsilateral to the ICH can occur. This is associated with poor clinical status, ventricular hemorrhage, lower cerebral perfusion pressure and worse clinical outcome.
Department of Neurology, Neurocenter, University of Freiburg, Breisacherstr. 64, 79106 Freiburg, Germany. matthias.reinhard@uniklinik-freiburg.de
Matthias
M
Reinhard
Florian
F
Neunhoeffer
Thomas A
TA
Gerds
Wolf-Dirk
WD
Niesen
Klaus-Juergen
KJ
Buttler
Jens
J
Timmer
Bernhard
B
Schmidt
Marek
M
Czosnyka
Cornelius
C
Weiller
Andreas
A
Hetzel
D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000502:physiology; D003128:Coma / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology*; D005260:Female; D015600:Glasgow Coma Scale; D006706:Homeostasis / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000517:prevention & control; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D017585:Ultrasonography, Doppler, Transcranial