Timing of diffusion weighted imaging lesions in spontaneous intracerebral hemorrhage

Garg, Rajeev; Alberawi, Mohammad; Ouyang, Bo; John, Sayona; Silva, Iván da; Shepherd, Starane; Koçak, Mehmet; Bhabad, Sudeep; Hall, Deborah A.; Jhaveri, Miral D.; Bleck, Thomas P.

doi:10.1016/j.jns.2021.117434

Cited by 3 publications

(1 citation statement)

References 22 publications

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“…Small DWI lesions may be a manifestation of active vasculopathy and coexist with ICH or present secondarily after ICH. A longitudinal study 2 observed that 35% of patients had DWI lesions at baseline, and 22% had new DWI lesions at 1 month that had not been present at baseline, while another longitudinal study 29 indicated that 50% had new DWI lesions at 1 week. Patients with microangiopathy had reduced cerebral autoregulation.…”

Section: Discussionmentioning

confidence: 99%

Ischemia in intracerebral hemorrhage: A comparative study of small‐vessel and large‐vessel diseases

Zhang

Ren

Deng

et al. 2022

Ann Clin Transl Neurol

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Objective: This study aimed to compare effects of cerebral small-vessel disease (cSVD) burden and cerebral artery stenosis (CAS) on acute ischemia in intracerebral hemorrhage (ICH) and their interaction with mean arterial pressure (MAP) change. Methods: We recruited consecutive patients with acute primary ICH. Brain magnetic resonance imaging and angiography were performed to quantify diffusion-weighted imaging (DWI) lesions, CAS, and cSVD markers, which were calculated for the total cSVD score. Multivariable regression models were adopted to explore their associations by DWI lesions size (<15 vs. ≥15 mm) and median MAP change stratification. Results: Of 305 included patients (mean age 59.5 years, 67.9% males), 77 (25.2%) had DWI lesions (small, 79.2%; large, 20.8%) and 67 (22.0%) had moderate and severe CAS. In multivariable analysis, small DWI lesions were independently associated with higher total cSVD score (odds ratio [OR] 1.81, 95% confidence interval [CI] 1.36-2.41). and large DWI lesions were associated with more severe CAS (OR 2.51, 95% CI 1.17-5.38). This association was modified by MAP change (interaction p = 0.016), with stratified analysis showing an increased risk of large DWI lesions in severe CAS with greater MAP change (≥44 mmHg) (OR 3.48, 95% CI 1.13-10.74) but not with mild MAP change (<44 mmHg) (OR 1.21,. Interpretation: Total cSVD burden is associated with small DWI lesions, whereas the degree of CAS is associated with large DWI lesions, specifically with greater MAP change, suggesting that large-artery atherosclerosis may be involved in ischemic brain injury, which is different from small-vessel pathogenesis in ICH.

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Section: Discussionmentioning

confidence: 99%