title: Acute brain infarcts after spontaneous intracerebral hemorrhage: a diffusion-weighted imaging study.
abstract: OBJECTIVE
  We aimed to determine the prevalence of acute brain infarcts using diffusion-weighted imaging (DWI) in patients with spontaneous intracerebral hemorrhage (ICH).
  
  
  METHODS
  We collected data on consecutive patients with spontaneous ICH admitted to our institution between August 1, 2006 and December 31, 2008 and in whom DWI was performed within 28 days of admission. Patients with hemorrhage attributable to trauma, tumor, aneurysm, vascular malformation, and hemorrhagic conversion of arterial or venous infarction were excluded. Restricted diffusion within, contiguous with, or immediately neighboring the hematoma or chronic infarcts was not considered abnormal. Using multivariable logistic regression, we evaluated potential predictors of DWI abnormality including clinical and radiographic characteristics and treatments. A probability value <0.05 was considered significant in the final model.
  
  
  RESULTS
  Among 118 spontaneous ICH patients (mean 59.6 years, 47.5% male, and 31.4% white) who also underwent MRI, DWI abnormality was observed in 22.9%. The majority of infarcts were small (median volume 0.25 mL), subcortical (70.4%), and subclinical (88.9%). Factors independently associated with DWI abnormality were prior ischemic stroke (P=0.002), MAP lowering by > or =40% (P=0.004), and craniotomy for ICH evacuation (P=0.001).
  
  
  CONCLUSIONS
  We found that acute brain infarction is relatively common after acute spontaneous ICH. Several factors, including aggressive blood pressure lowering, may be associated with acute ischemic infarcts after ICH. These preliminary findings require further prospective study.
authors.affiliation: Department of Neurological Sciences, Rush University Medical Center, 1725 W Harrison St Suite 1121, Chicago, IL 60612, USA. shyam_prabhakaran@rush.edu
authors.forename: Shyam
authors.initials: S
authors.lastname: Prabhakaran
authors.forename: Rajesh
authors.initials: R
authors.lastname: Gupta
authors.forename: Bichun
authors.initials: B
authors.lastname: Ouyang
authors.forename: Sayona
authors.initials: S
authors.lastname: John
authors.forename: Richard E
authors.initials: RE
authors.lastname: Temes
authors.forename: Yousef
authors.initials: Y
authors.lastname: Mohammad
authors.forename: Vivien H
authors.initials: VH
authors.lastname: Lee
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Bleck
mesh_terms: D000368:Aged; D044383:Black People; D020520:Brain Infarction / Q000175:diagnosis* / Q000209:etiology*; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000175:diagnosis*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D044465:White People