title: Predictors of highly prevalent brain ischemia in intracerebral hemorrhage.
abstract: OBJECTIVE
  This study was undertaken to determine the prevalence, characteristics, risk factors, and temporal profile of concurrent ischemic lesions in patients with acute primary intracerebral hemorrhage (ICH).
  
  
  METHODS
  Patients were recruited within a prospective, longitudinal, magnetic resonance imaging (MRI)-based study of primary ICH. Clinical, demographic, and MRI data were collected on all subjects at baseline and 1 month.
  
  
  RESULTS
  Of the 138 patients enrolled, mean age was 59 years, 54% were male, 73% were black, and 84% had a history of hypertension. At baseline, ischemic lesions on diffusion-weighted imaging (DWI) were found in 35% of patients. At 1 month, lesions were present in 27%, and of these lesions, 83% were new and not present at baseline. ICH volume (p = 0.025), intraventricular hemorrhage (p = 0.019), presence of microbleeds (p = 0.024), and large, early reductions in mean arterial pressure (p = 0.003) were independent predictors of baseline DWI lesions. A multivariate logistical model predicting the presence of 1-month DWI lesions included history of any prior stroke (p = 0.012), presence of 1 or more microbleeds (p = 0.04), black race (p = 0.641), and presence of a DWI lesion at baseline (p = 0.007).
  
  
  CONCLUSIONS
  This study demonstrates that >⅓ of patients with primary ICH have active cerebral ischemia at baseline remote from the index hematoma, and ¼ of patients experience ongoing, acute ischemic events at 1 month. Multivariate analyses implicate blood pressure reductions in the setting of an active vasculopathy as a potential underlying mechanism. Further studies are needed to determine the impact of these lesions on outcome and optimal management strategies to arrest vascular damage.
authors.affiliation: Department of Neurology, Georgetown University, Washington, DC, USA. rsm53@georgetown.edu
authors.forename: Ravi S
authors.initials: RS
authors.lastname: Menon
authors.forename: Richard E
authors.initials: RE
authors.lastname: Burgess
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Wing
authors.forename: M Christopher
authors.initials: MC
authors.lastname: Gibbons
authors.forename: Nawar M
authors.initials: NM
authors.lastname: Shara
authors.forename: Stephen
authors.initials: S
authors.lastname: Fernandez
authors.forename: Annapurni
authors.initials: A
authors.lastname: Jayam-Trouth
authors.forename: Laura
authors.initials: L
authors.lastname: German
authors.forename: Ian
authors.initials: I
authors.lastname: Sobotka
authors.forename: Dorothy
authors.initials: D
authors.lastname: Edwards
authors.forename: Chelsea S
authors.initials: CS
authors.lastname: Kidwell
mesh_terms: D000208:Acute Disease; D000368:Aged; D044383:Black People; D002545:Brain Ischemia / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology*; D002543:Cerebral Hemorrhage / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology*; D015897:Comorbidity; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014481:United States; D001741:Black or African American