From the Department of Neurology, Division of Critical Care Neurology
(S.A.M., M.E.F., C.E.T., R.S.), and the Department of Radiology, Division of
Nuclear Medicine (A.L., D.B.K., R.L.Van H.), Columbia-Presbyterian Medical
Center, New York, NY.
Correspondence and reprint requests to Stephan A. Mayer, MD, Neurological Institute, 710 W 168th St, Box 39, New York, NY 10032. E-mail sam14{at}columbia.edu
Background and Purpose—Secondary
brain injury and edema formation contribute significantly to morbidity
and mortality after intracerebral hemorrhage
(ICH). The pathogenesis of this process is poorly understood. We sought
to characterize alterations in perilesional blood flow that occur
during the acute phase of ICH and to determine whether progressive
enlargement of edema surrounding ICH is related to increased or
decreased perfusion.
Methods—We performed paired consecutive CT and
99mTc-hexamethylpropylenamine oxime single-photon emission
computed tomography (SPECT) scans during the acute (mean, 18 hours) and
subacute (mean, 72 hours) phase of ICH in 23 patients. Hematoma and
edema volumes were traced and calculated from CT images. SPECT-derived
hypothetical flow deficit volumes (FDV) around each hematoma were
calculated by measuring a "zero-flow" volume within a large
perilesional region of interest (based on percent tracer count loss
compared with the contralateral side) and subtracting the corresponding
ICH volume. Patients with significant midline shift (>5 mm) or
global blood flow reduction were excluded from the
analysis.
Results—ICH volume (18 mL) did not change, mean edema volume
increased by 36% (from 19 to 25 mL, P<0.0001), and
mean FDV decreased by 55% (from 14 to 6 mL, P=0.0004)
between the acute and subacute phases. Edema volume on the second
CT scan correlated positively with FDV on the first SPECT scan
(Spearman's
Conclusions—Perilesional blood flow normalizes from initially
depressed levels as edema forms during the first 72 hours after ICH,
and the eventual extent of edema correlates with the volume of
reperfused tissue. These results suggest that the potential for
perilesional ischemia is highest in the earliest hours after
ICH onset and implicate reperfusion injury in the pathogenesis of
perihematoma edema formation.
© 1998 American Heart Association, Inc.
Original Contributions
Perilesional Blood Flow and Edema Formation in Acute Intracerebral Hemorrhage
A SPECT Study
=0.48, P=0.02), and with the volume of
reperfused perilesional tissue
(FDVacute-FDVsubacute) (Spearman's
=0.41, P=0.05). Perilesional edema on CT
always corresponded topographically with perfusion deficits on SPECT.
In 4 patients, delayed focal hyperemia was identified in more
peripheral cortical regions, but these areas appeared
normal on CT.
Key Words: brain edema • cerebral blood flow • intracerebral hemorrhage • tomography, emission computed • tomography, x-ray computed
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