Fate of Diffusion Restricted Lesions in Acute Intracerebral Hemorrhage

Tsai, Yuan-Hsiung; Lee, Ming-Hsueh; Weng, Hsu–Huei; Chang, Shin-Tsu; Yang, Jen-Tsung; Huang, Yen-Chu

doi:10.1371/journal.pone.0105970

Cited by 32 publications

(53 citation statements)

References 27 publications

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“…In our cohort, we observed acute ischaemic lesions among 15.5% of patients with acute ICH within 10 days after symptom onset. These results are in line with the prevalence reported in previous studies, ranging from 11% to 41% . As previously described, we found that patients with lobar ICH more frequently had DWI lesions than those with deep ICH .…”

Section: Discussionsupporting

confidence: 93%

Acute ischaemic lesions are associated with cortical superficial siderosis in spontaneous intracerebral hemorrhage

Revel-Mouroz

Viguier

Cazzola

et al. 2018

Euro J of Neurology

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Background and purpose Diffusion‐weighted imaging (DWI) commonly detects acute ischaemic lesions in patients with acute intracerebral hemorrhage (ICH), especially with cerebral amyloid angiopathy (CAA). We investigated the relationship between cortical superficial siderosis (cSS), a neuroimaging marker of CAA, and DWI lesions in patients with acute ICH. Methods We conducted a retrospective analysis of prospectively collected data from consecutive patients with acute supratentorial ICH who underwent brain magnetic resonance imaging within 10 days after symptom onset. Magnetic resonance imaging scans were analyzed for DWI lesions, cSS and other markers for small‐vessel disease. Univariate and multivariate analyses were performed to assess the association between cSS and DWI lesions. Results Among 246 ICH survivors (mean age 71.4 ± 12.6 years) who were enrolled, 126 had lobar ICH and 120 had deep ICH. Overall, DWI lesions were observed in 38 (15.4%) patients and were more common in patients with lobar ICH than deep ICH (22.2% vs. 8.3%; P = 0.003). In multivariate logistic regression analysis, the extent of white matter hyperintensities [odds ratio (OR), 1.29; 95% confidence interval (CI), 1.05–1.58; P = 0.02] and cSS severity (focal cSS: OR, 3.54; 95% CI, 1.28–9.84; disseminated cSS: OR, 4.41; 95% CI, 1.78–10.97; P = 0.001) were independently associated with the presence of DWI lesions. Conclusions Diffusion‐weighted imaging lesions are more frequently observed in patients with acute lobar ICH than in those with deep ICH. cSS severity and white matter hyperintensity extent are independent predictors for the presence of DWI lesions, suggesting that CAA may be involved in the pathogenesis of DWI lesions associated with acute ICH.

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Section: Discussionsupporting

confidence: 93%

Acute ischaemic lesions are associated with cortical superficial siderosis in spontaneous intracerebral hemorrhage

Revel-Mouroz

Viguier

Cazzola

et al. 2018

Euro J of Neurology

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“…[5][6][7][8][9][10] Over the last several years, a growing number of studies have characterized the presence and frequency of ischemic lesions remote from the acute hematoma visualized on diffusion-weighted imaging (DWI) in patients with primary ICH undergoing MRI. [11][12][13][14][15][16][17][18][19] Across these series, remote DWI lesions are visualized in 11%-41% of patients. There have been conflicting reports of an association between DWI lesions and large fluctuations in BP in the acute hospital setting.…”

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confidence: 87%

“…There have been conflicting reports of an association between DWI lesions and large fluctuations in BP in the acute hospital setting. 11,12,14,16,17 However, the mechanism and etiology of the lesions remains unclear, as does the potential association with poor outcomes. In these prior studies, the sample sizes were relatively small, with the majority being singlecenter retrospective case series.…”

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confidence: 99%

Ischemic lesions, blood pressure dysregulation, and poor outcomes in intracerebral hemorrhage

et al. 2017

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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 (6SD) age was 60.8 6 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 5 0.006). A logistic regression model of variables associated with DWI lesions included lower age (odds ratio [OR] 0.721, p 5 0.002), higher first recorded systolic BP (10-unit OR 1.12, p 5 0.002), greater change in mean arterial pressure (MAP) prior to the MRI (10-unit OR 1.10, p 5 0.037), microbleeds (OR 1.99, p 5 0.008), and higher white matter hyperintensity (WMH) score (1-unit OR 1.16, p 5 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 5 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. Neurology ® 2017;88:782-788 GLOSSARY ADC 5 apparent diffusion coefficient; BP 5 blood pressure; CAA 5 cerebral amyloid angiopathy; DWI 5 diffusion-weighted imaging; ERICH 5 Ethnic/Racial Variations of Intracerebral Hemorrhage; FLAIR 5 fluid-attenuated inversion recovery; GCS 5 Glasgow Coma Scale; GRE 5 gradient recalled echo; ICH 5 intracerebral hemorrhage; INTERACT2 5 Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage 2; IVH 5 intraventricular hemorrhage; MAP 5 mean arterial pressure; mRS 5 modified Rankin Scale; SBP 5 systolic blood pressure; SWI 5 susceptibility-weighted imaging; WMH 5 white matter hyperintensity.Primary intracerebral hemorrhage (ICH) is the second most common cause of stroke, affecting over 1 million people worldwide each year.1,2 ICH causes significantly greater morbidity and mortality than ischemic stroke. Hypertension is the most common risk factor for ICH. Elevated blood pressure (BP), often at extreme levels, frequently occurs in the hyperacute and acute phases of primary ICH and is associated with hemorrhage expansion and poor outcome. 3,4 Several recent trials have sought to determine whether intensive lowering of BP acutely improves outcomes in patients with ICH. 5-10Over the last several years, a growing number of studies have characte...

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“…In this cohort of patients with spontaneous ICH, we found that NLR was elevated in approximately 43.5% (71/163) of patients. In the univariate analysis, patients with elevated NLR had a median GCS of 13 and a median NIH stroke scale of 9 when compared with patients without elevated NLR (GCS: 15 [14‐15], P = .001; NIH stroke scale: 6 [3‐10], P = .005). In addition, those patients were prone to have a higher parenchymal hematoma volume and IVH extension.…”

Section: Resultsmentioning

confidence: 99%

“…Moreover, the presence of intracerebral remote diffusion‐weighted imaging lesions (R‐DWILs) has been known to worsen the stroke outcome . R‐DWILs are defined as focal hyperintensities remote from the site of the ICH or the peri‐hematoma region on diffusion‐weighted images, which are detected in about 11%‐41% of ICH patients . It is an essential complication that requires attention owing to its significant effect on the increased risk of recurrent ICH, cognitive impairment, and mortality.…”

Section: Introductionmentioning

confidence: 99%

Early elevated neutrophil‐to‐lymphocyte ratio associated with remote diffusion‐weighted imaging lesions in acute intracerebral hemorrhage

Chen

et al. 2019

CNS Neurosci Ther

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Aims To explore the relationship between the circulating neutrophil‐to‐lymphocyte ratio (NLR) and the remote diffusion‐weighted imaging lesions (R‐DWILs) after spontaneous intracerebral hemorrhage (ICH). Methods Consecutive patients with spontaneous ICH were prospectively collected from November 2016 to May 2018 and retrospectively analyzed. We included subjects who presented within 24 hours after symptom onset and were free of detectable infections on admission or in hospital. Blood samples were obtained at 24‐48 hours after ICH ictus, while all complete MRI scans were performed at 5‐8 days. R‐DWILs were defined as focal hyperintensities remote from the site of the ICH or the peri‐hematoma regions. NLR was calculated by dividing the absolute neutrophil counts by the absolute lymphocyte counts. Multivariate binary logistic regression models were generated to evaluate the relationship between NLR and R‐DWILs. Results One hundred sixty‐three subjects met eligibility criteria (age 62.3 ± 13.6 years, 60.7% males), of whom 31(19.0%) experienced R‐DWILs. Higher circulating NLR was documented in patients with R‐DWILs. With the best cutoff value of 6.01, elevated NLR was independently associated with the presence of R‐DWILs (OR = 3.170, 95% CI 1.306‐7.697, P = .011) in the bivariate logistic regression analysis with adjustment for age, sex, atrial fibrillation, previous ischemic stroke/TIA, SBP on admission, hematoma volume, and IVH. Conclusions This study provides significant evidence of the association between circulating NLR and R‐DWILs in spontaneous ICH patients. Patients with NLR > 6.01 at 24‐48 hours after ICH ictus should be paid more attention to when evaluating R‐DWILs.

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Fate of Diffusion Restricted Lesions in Acute Intracerebral Hemorrhage

Cited by 32 publications

References 27 publications

Acute ischaemic lesions are associated with cortical superficial siderosis in spontaneous intracerebral hemorrhage

Acute ischaemic lesions are associated with cortical superficial siderosis in spontaneous intracerebral hemorrhage

Ischemic lesions, blood pressure dysregulation, and poor outcomes in intracerebral hemorrhage

Early elevated neutrophil‐to‐lymphocyte ratio associated with remote diffusion‐weighted imaging lesions in acute intracerebral hemorrhage

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