title: Ischemic lesions, blood pressure dysregulation, and poor outcomes in intracerebral hemorrhage.
abstract: OBJECTIVE
  To evaluate the associations among diffusion-weighted imaging (DWI) lesions, blood pressure (BP) dysregulation, MRI markers of small vessel disease, and poor outcome in a large, prospective study of primary intracerebral hemorrhage (ICH).
  
  
  METHODS
  The Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study is a multicenter, observational study of ICH among white, black, and Hispanic patients.
  
  
  RESULTS
  Of 600 patients, mean (±SD) age was 60.8 ± 13.6 years, median (interquartile range) ICH volume was 9.1 mL (3.5-20.8), and 79.6% had hypertension. Overall, 26.5% of cases had DWI lesions, and this frequency differed by race/ethnicity (black 33.8%, Hispanic 24.9%, white 20.2%, overallp= 0.006). A logistic regression model of variables associated with DWI lesions included lower age (odds ratio [OR] 0.721,p= 0.002), higher first recorded systolic BP (10-unit OR 1.12,p= 0.002), greater change in mean arterial pressure (MAP) prior to the MRI (10-unit OR 1.10,p= 0.037), microbleeds (OR 1.99,p= 0.008), and higher white matter hyperintensity (WMH) score (1-unit OR 1.16,p= 0.002) after controlling for race/ethnicity, leukocyte count, and acute in-hospital antihypertensive treatment. A second model of variables associated with poor 90-day functional outcome (modified Rankin Scale scores 4-6) included DWI lesion count (OR 1.085,p= 0.034) as well as age, ICH volume, intraventricular hemorrhage, Glasgow Coma Scale score, WMH score, race/ethnicity, acute in-hospital antihypertensive treatment, and ICH location.
  
  
  CONCLUSIONS
  These results support the hypotheses that acute BP dysregulation is associated with the development of DWI lesions in primary ICH and that DWI lesions are, in turn, associated with poor outcomes.
authors.affiliation: From the Departments of Neurology (C.S.K., G.N., S.D.) and Medical Imaging (C.S.K.), University of Arizona, Tucson; Department of Neurology and Center for Human Genetic Research (J.R., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Departments of Anesthesiology and Neurology (M.L.J.), Duke University, Durham, NC; Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology and Rehabilitation Medicine (M.L.F., J.O., C.J.M., D.W.), University of Cincinnati, College of Medicine, OH; and Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L.), Wake Forest University School of Medicine, Winston-Salem, NC. ckidwell@email.arizona.edu.
authors.forename: Chelsea S
authors.initials: CS
authors.lastname: Kidwell
authors.affiliation: From the Departments of Neurology (C.S.K., G.N., S.D.) and Medical Imaging (C.S.K.), University of Arizona, Tucson; Department of Neurology and Center for Human Genetic Research (J.R., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Departments of Anesthesiology and Neurology (M.L.J.), Duke University, Durham, NC; Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology and Rehabilitation Medicine (M.L.F., J.O., C.J.M., D.W.), University of Cincinnati, College of Medicine, OH; and Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L.), Wake Forest University School of Medicine, Winston-Salem, NC.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rosand
authors.affiliation: From the Departments of Neurology (C.S.K., G.N., S.D.) and Medical Imaging (C.S.K.), University of Arizona, Tucson; Department of Neurology and Center for Human Genetic Research (J.R., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Departments of Anesthesiology and Neurology (M.L.J.), Duke University, Durham, NC; Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology and Rehabilitation Medicine (M.L.F., J.O., C.J.M., D.W.), University of Cincinnati, College of Medicine, OH; and Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L.), Wake Forest University School of Medicine, Winston-Salem, NC.
authors.forename: Gina
authors.initials: G
authors.lastname: Norato
authors.affiliation: From the Departments of Neurology (C.S.K., G.N., S.D.) and Medical Imaging (C.S.K.), University of Arizona, Tucson; Department of Neurology and Center for Human Genetic Research (J.R., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Departments of Anesthesiology and Neurology (M.L.J.), Duke University, Durham, NC; Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology and Rehabilitation Medicine (M.L.F., J.O., C.J.M., D.W.), University of Cincinnati, College of Medicine, OH; and Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L.), Wake Forest University School of Medicine, Winston-Salem, NC.
authors.forename: Simone
authors.initials: S
authors.lastname: Dixon
authors.affiliation: From the Departments of Neurology (C.S.K., G.N., S.D.) and Medical Imaging (C.S.K.), University of Arizona, Tucson; Department of Neurology and Center for Human Genetic Research (J.R., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Departments of Anesthesiology and Neurology (M.L.J.), Duke University, Durham, NC; Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology and Rehabilitation Medicine (M.L.F., J.O., C.J.M., D.W.), University of Cincinnati, College of Medicine, OH; and Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L.), Wake Forest University School of Medicine, Winston-Salem, NC.
authors.forename: Bradford B
authors.initials: BB
authors.lastname: Worrall
authors.affiliation: From the Departments of Neurology (C.S.K., G.N., S.D.) and Medical Imaging (C.S.K.), University of Arizona, Tucson; Department of Neurology and Center for Human Genetic Research (J.R., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Departments of Anesthesiology and Neurology (M.L.J.), Duke University, Durham, NC; Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology and Rehabilitation Medicine (M.L.F., J.O., C.J.M., D.W.), University of Cincinnati, College of Medicine, OH; and Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L.), Wake Forest University School of Medicine, Winston-Salem, NC.
authors.forename: Michael L
authors.initials: ML
authors.lastname: James
authors.affiliation: From the Departments of Neurology (C.S.K., G.N., S.D.) and Medical Imaging (C.S.K.), University of Arizona, Tucson; Department of Neurology and Center for Human Genetic Research (J.R., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Departments of Anesthesiology and Neurology (M.L.J.), Duke University, Durham, NC; Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology and Rehabilitation Medicine (M.L.F., J.O., C.J.M., D.W.), University of Cincinnati, College of Medicine, OH; and Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L.), Wake Forest University School of Medicine, Winston-Salem, NC.
authors.forename: Mitchell S V
authors.initials: MS
authors.lastname: Elkind
authors.affiliation: From the Departments of Neurology (C.S.K., G.N., S.D.) and Medical Imaging (C.S.K.), University of Arizona, Tucson; Department of Neurology and Center for Human Genetic Research (J.R., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Departments of Anesthesiology and Neurology (M.L.J.), Duke University, Durham, NC; Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology and Rehabilitation Medicine (M.L.F., J.O., C.J.M., D.W.), University of Cincinnati, College of Medicine, OH; and Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L.), Wake Forest University School of Medicine, Winston-Salem, NC.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Flaherty
authors.affiliation: From the Departments of Neurology (C.S.K., G.N., S.D.) and Medical Imaging (C.S.K.), University of Arizona, Tucson; Department of Neurology and Center for Human Genetic Research (J.R., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Departments of Anesthesiology and Neurology (M.L.J.), Duke University, Durham, NC; Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology and Rehabilitation Medicine (M.L.F., J.O., C.J.M., D.W.), University of Cincinnati, College of Medicine, OH; and Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L.), Wake Forest University School of Medicine, Winston-Salem, NC.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Osborne
authors.affiliation: From the Departments of Neurology (C.S.K., G.N., S.D.) and Medical Imaging (C.S.K.), University of Arizona, Tucson; Department of Neurology and Center for Human Genetic Research (J.R., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Departments of Anesthesiology and Neurology (M.L.J.), Duke University, Durham, NC; Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology and Rehabilitation Medicine (M.L.F., J.O., C.J.M., D.W.), University of Cincinnati, College of Medicine, OH; and Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L.), Wake Forest University School of Medicine, Winston-Salem, NC.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Vashkevich
authors.affiliation: From the Departments of Neurology (C.S.K., G.N., S.D.) and Medical Imaging (C.S.K.), University of Arizona, Tucson; Department of Neurology and Center for Human Genetic Research (J.R., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Departments of Anesthesiology and Neurology (M.L.J.), Duke University, Durham, NC; Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology and Rehabilitation Medicine (M.L.F., J.O., C.J.M., D.W.), University of Cincinnati, College of Medicine, OH; and Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L.), Wake Forest University School of Medicine, Winston-Salem, NC.
authors.forename: Carl D
authors.initials: CD
authors.lastname: Langefeld
authors.affiliation: From the Departments of Neurology (C.S.K., G.N., S.D.) and Medical Imaging (C.S.K.), University of Arizona, Tucson; Department of Neurology and Center for Human Genetic Research (J.R., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Departments of Anesthesiology and Neurology (M.L.J.), Duke University, Durham, NC; Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology and Rehabilitation Medicine (M.L.F., J.O., C.J.M., D.W.), University of Cincinnati, College of Medicine, OH; and Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L.), Wake Forest University School of Medicine, Winston-Salem, NC.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Moomaw
authors.affiliation: From the Departments of Neurology (C.S.K., G.N., S.D.) and Medical Imaging (C.S.K.), University of Arizona, Tucson; Department of Neurology and Center for Human Genetic Research (J.R., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Departments of Anesthesiology and Neurology (M.L.J.), Duke University, Durham, NC; Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology and Rehabilitation Medicine (M.L.F., J.O., C.J.M., D.W.), University of Cincinnati, College of Medicine, OH; and Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L.), Wake Forest University School of Medicine, Winston-Salem, NC.
authors.forename: Daniel
authors.initials: D
authors.lastname: Woo
mesh_terms: D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination; D001921:Brain / Q000000981:diagnostic imaging*; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000208:ethnology / Q000503:physiopathology* / Q000628:therapy; D016022:Case-Control Studies; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging* / Q000208:ethnology / Q000503:physiopathology / Q000628:therapy*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D016896:Treatment Outcome; D014481:United States