Published online before print June 12, 2003, doi: 10.1161/01.STR.0000076010.10696.55
(Stroke. 2003;34:1674.)
© 2003 American Heart Association, Inc.
Original Contributions |
Stroke MRI in Intracerebral Hemorrhage
Is There a Perihemorrhagic Penumbra?
From the Departments of Neurology (P.D.S., K.H., K.B., B.O., R.K., E.J., S.S., W.H.) and Neuroradiology (J.B.F., P.S., K.S.), University of Heidelberg, Heidelberg, Germany.
Correspondence to Peter D. Schellinger, MD, Neurologische Universitätsklinik, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany. E-mail Peter_Schellinger{at}med.uni-heidelberg.de
Background and Purpose— Cerebral ischemia has been proposed as a contributing mechanism to secondary neuronal injury after intracerebral hemorrhage (ICH). The search for surrogate parameters that allow treatment stratification for spontaneous ICH continues. We sought to assess the presence and prognostic effect of perihemorrhagic ischemic changes and hypoperfusion in a prospective stroke MRI study.
Methods— We performed stroke MRI in 32 patients with hyperacute ICH (mean, 16.9±17.2 mL) within 6 hours after symptom onset (mean, 3.1±1.3 hours). Clinical data at baseline (National Institutes of Health Stroke Scale) and on day 90 (Barthel Index, modified Rankin Scale) were assessed. Perihemorrhagic perfusion- and diffusion-weighted imaging changes were assessed in a 1-cm-wide area around the clot.
Results— Despite a mild perihemorrhagic mean transit time prolongation of 0.7±1.1 second, there were no significant perihemorrhagic apparent diffusion coefficient or mean transit time changes indicating irreversible ischemia or hypoperfusion. ICH size, time to imaging, or clinical severity at baseline or outcome were not reflected by changes of relative apparent diffusion coefficient or perfusion-weighted imaging. ICH size correlated with baseline clinical severity (r=0.51, P=0.005). There was a significant association (P=0.0494) and a significant negative correlation (r=-0.468, P=0.0103) of perihemorrhagic perfusion change with time from symptom onset not associated with ICH size.
Conclusions— Perihemorrhagic hypoperfusion probably is a consequence of reduced metabolic demand (diaschisis) rather than a sign of ischemia. We found no evidence for a perihemorrhagic and potentially salvageable ischemic penumbra in hyperacute ICH. Further studies should address metabolic, toxic, apoptotic, and microvascular aspects.
Key Words: intracerebral hemorrhage • magnetic resonance imaging, diffusion-weighted • magnetic resonance imaging, perfusion-weighted • penumbra • risk
This article has been cited by other articles:
 |
|
 |
|
  P. Delgado, E. Cuadrado, A. Rosell, J. Alvarez-Sabin, A. Ortega-Aznar, M. Hernandez-Guillamon, A. Penalba, C. A. Molina, and J. Montaner Fas System Activation in Perihematomal Areas After Spontaneous Intracerebral Hemorrhage Stroke, June 1, 2008; 39(6): 1730 - 1734. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Herweh, E. Juttler, P. D. Schellinger, E. Klotz, E. Jenetzky, B. Orakcioglu, K. Sartor, and P. Schramm Evidence Against a Perihemorrhagic Penumbra Provided by Perfusion Computed Tomography Stroke, November 1, 2007; 38(11): 2941 - 2947. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Wada, R. I. Aviv, A. J. Fox, D. J. Sahlas, D. J. Gladstone, G. Tomlinson, and S. P. Symons CT Angiography "Spot Sign" Predicts Hematoma Expansion in Acute Intracerebral Hemorrhage Stroke, April 1, 2007; 38(4): 1257 - 1262. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. H. Tayal, R. Gupta, H. Yonas, T. Jovin, K. Uchino, M. Hammer, L. Wechsler, and J. M. Gebel Quantitative Perihematomal Blood Flow in Spontaneous Intracerebral Hemorrhage Predicts In-Hospital Functional Outcome Stroke, February 1, 2007; 38(2): 319 - 324. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Steiner, J. Rosand, and M. Diringer Intracerebral Hemorrhage Associated With Oral Anticoagulant Therapy: Current Practices and Unresolved Questions Stroke, January 1, 2006; 37(1): 256 - 262. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
NINDS ICH Workshop Participants Priorities for Clinical Research in Intracerebral Hemorrhage: Report From a National Institute of Neurological Disorders and Stroke Workshop Stroke, March 1, 2005; 36(3): e23 - e41. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. D. Ardizzone, A. Lu, K. R. Wagner, Y. Tang, R. Ran, and F. R. Sharp Glutamate Receptor Blockade Attenuates Glucose Hypermetabolism in Perihematomal Brain After Experimental Intracerebral Hemorrhage in Rat Stroke, November 1, 2004; 35(11): 2587 - 2591. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. S. Butcher, T. Baird, L. MacGregor, P. Desmond, B. Tress, and S. Davis Perihematomal Edema in Primary Intracerebral Hemorrhage Is Plasma Derived Stroke, August 1, 2004; 35(8): 1879 - 1885. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Alvarez-Sabin, P. Delgado, S. Abilleira, C. A. Molina, J. Arenillas, M. Ribo, E. Santamarina, M. Quintana, J. Monasterio, and J. Montaner Temporal Profile of Matrix Metalloproteinases and Their Inhibitors After Spontaneous Intracerebral Hemorrhage: Relationship to Clinical and Radiological Outcome Stroke, June 1, 2004; 35(6): 1316 - 1322. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. F. Hanley and W. Hacke Critical Care and Emergency Medicine Neurology Stroke, February 1, 2004; 35(2): 365 - 366. [Full Text] [PDF]
|
|
|
|
|
|
J. B. Fiebach, P. D. Schellinger, A. Gass, T. Kucinski, M. Siebler, A. Villringer, P. Olkers, J. G. Hirsch, S. Heiland, P. Wilde, et al. Stroke Magnetic Resonance Imaging Is Accurate in Hyperacute Intracerebral Hemorrhage: A Multicenter Study on the Validity of Stroke Imaging Stroke, February 1, 2004; 35(2): 502 - 506. [Abstract] [Full Text] [PDF]
|
|