Chelsea S Kidwell1, Jonathan Rosand2, Gina Norato2, Simone Dixon2, Bradford B Worrall2, Michael L James2, Mitchell S V Elkind2, Matthew L Flaherty2, Jennifer Osborne2, Anastasia Vashkevich2, Carl D Langefeld2, Charles J Moomaw2, Daniel Woo2. 1. 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. 2. 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.
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.
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.
Authors: Franz Fazekas; F Barkhof; L O Wahlund; L Pantoni; T Erkinjuntti; P Scheltens; R Schmidt Journal: Cerebrovasc Dis Date: 2002 Impact factor: 2.762
Authors: Adnan I Qureshi; Yuko Y Palesch; Reneé Martin; Jill Novitzke; Salvador Cruz-Flores; As'ad Ehtisham; Mustapha A Ezzeddine; Joshua N Goldstein; Haitham M Hussein; M Fareed K Suri; Nauman Tariq Journal: Arch Neurol Date: 2010-05
Authors: Richard E Burgess; Steven Warach; Timothy J Schaewe; Brittany R Copenhaver; Jeffry R Alger; Paul Vespa; Neil Martin; Jeffrey L Saver; Chelsea S Kidwell Journal: Stroke Date: 2008-05-15 Impact factor: 7.914
Authors: B R Copenhaver; A W Hsia; J G Merino; R E Burgess; J T Fifi; L Davis; S Warach; C S Kidwell Journal: Neurology Date: 2008-10-07 Impact factor: 9.910
Authors: Craig S Anderson; Yining Huang; Ji Guang Wang; Hisatomi Arima; Bruce Neal; Bin Peng; Emma Heeley; Christian Skulina; Mark W Parsons; Jong Sung Kim; Qing Ling Tao; Yue Chun Li; Jian Dong Jiang; Li Wen Tai; Jin Li Zhang; En Xu; Yan Cheng; Stephane Heritier; Lewis B Morgenstern; John Chalmers Journal: Lancet Neurol Date: 2008-04-07 Impact factor: 44.182
Authors: Rita V Krishnamurthi; Valery L Feigin; Mohammad H Forouzanfar; George A Mensah; Myles Connor; Derrick A Bennett; Andrew E Moran; Ralph L Sacco; Laurie M Anderson; Thomas Truelsen; Martin O'Donnell; Narayanaswamy Venketasubramanian; Suzanne Barker-Collo; Carlene M M Lawes; Wenzhi Wang; Yukito Shinohara; Emma Witt; Majid Ezzati; Mohsen Naghavi; Christopher Murray Journal: Lancet Glob Health Date: 2013-10-24 Impact factor: 26.763
Authors: Rajeev K Garg; Jawad Khan; Robert J Dawe; James Conners; Sayona John; Shyam Prabhakaran; Mehmet Kocak; Sudeep Bhabad; Sean L Simpson; Bichun Ouyang; Miral Jhaveri; Thomas P Bleck Journal: Neurocrit Care Date: 2020-10 Impact factor: 3.210
Authors: Lucia Rivera-Lara; Santosh B Murthy; Saman Nekoovaght-Tak; Hasan Ali; Nichol McBee; Rachel Dlugash; Malathi Ram; Richard Thompson; Issam A Awad; Daniel F Hanley; Wendy C Ziai Journal: Neurocrit Care Date: 2018-10 Impact factor: 3.210
Authors: Eva A Rocha; Felipe Rocha; Izadora Deliberalli; João Brainer C de Andrade; Irapuá F Ricarte; Aneesh B Singhal; Gisele S Silva Journal: Neurocrit Care Date: 2020-08-07 Impact factor: 3.210