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Kidwell CS, Rosand J, Norato G, Dixon S, Worrall BB, James ML, Elkind MSV, Flaherty ML, Osborne J, Vashkevich A, Langefeld CD, Moomaw CJ, Woo D. Ischemic lesions, blood pressure dysregulation, and poor outcomes in intracerebral hemorrhage. Neurology 2017; 88:782-788. [PMID: 28122903 DOI: 10.1212/wnl.0000000000003630] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 11/28/2016] [Indexed: 12/20/2022] Open
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%, overall p = 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.
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Affiliation(s)
- Chelsea S Kidwell
- 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.
| | - Jonathan Rosand
- 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
| | - Gina Norato
- 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
| | - Simone Dixon
- 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
| | - Bradford B Worrall
- 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
| | - Michael L James
- 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
| | - Mitchell S V Elkind
- 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
| | - Matthew L Flaherty
- 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
| | - Jennifer Osborne
- 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
| | - Anastasia Vashkevich
- 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
| | - Carl D Langefeld
- 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
| | - Charles J Moomaw
- 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
| | - Daniel Woo
- 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
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