Hyperacute injury marker (HARM) in primary hemorrhage: a distinct form of CNS barrier disruption.
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.
Department of Neurology and Georgetown Stroke Center, 4000 Reservoir Road, NW, Building D, Suite 150, Georgetown University Medical Center, Washington, DC 20007, USA. ck256@georgetown.edu
C S
CS
Kidwell
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R
Burgess
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R
Menon
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S
Warach
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LL
Latour
D000368:Aged; D015415:Biomarkers / Q000134:cerebrospinal fluid; D001812:Blood-Brain Barrier / Q000378:metabolism / Q000503:physiopathology*; D002543:Cerebral Hemorrhage / Q000134:cerebrospinal fluid* / Q000145:classification / Q000503:physiopathology*; D015331:Cohort Studies; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
D015415:Biomarkers