Published Online
on June 22, 2006

A more recent version of this article appeared on August 1, 2006

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Submitted on December 22, 2005
Revised on March 22, 2006
Accepted on March 28, 2006

Lack of Evidence for an Association Between Hemodynamic Variables and Hematoma Growth in Spontaneous Intracerebral Hemorrhage

Edward C. Jauch MD, MS^*; Christopher J. Lindsell PhD; Opeolu Adeoye MD; Jane Khoury MS; William Barsan MD; Joseph Broderick MD; Arthur Pancioli MD; and Thomas Brott MD

From the Departments of Emergency Medicine (E.J.C., C.J.L., O.A., A.P.) and of Environmental Health (J.K.), University of Cincinnati Medical Center, Cincinnati, Ohio; the Department of Emergency Medicine (W.B.), University of Michigan, Ann Arbor; the Department of Neurology (J.B.), University of Cincinnati Medical Center, Cincinnati, Ohio; and the Department of Neurology (T.B.), Mayo Clinic Foundation, Jacksonville, Fla.

^* To whom correspondence should be addressed. E-mail: edward.jauch{at}uc.edu.

Background and Purpose--Early hematoma expansion in spontaneous intracerebral hemorrhage (ICH) is associated with worse clinical outcome. We hypothesized that hemodynamic parameters are associated with the increase in hematoma volume owing to their relationship to blood vessel wall stresses.

Methods--We performed a post hoc analysis of clinical and computed tomography (CT) data from patients enrolled in a prospective observational study of ICH patients presenting within 3 hours from symptom onset. Hematoma volumes were measured at hospital arrival and at 1 and 20 hours from presentation. Blood pressure and heart rate, recorded at 19 time points between presentation and 20 hours, were used to derive hemodynamic variables. Multivariable logistic-regression models were constructed to assess the relation between hemodynamic parameters and hematoma growth, adjusted for clinical covariates.

Results--From the original study, 98 patients underwent baseline and 1-hour CT scans; of these, 65 had 20-hour CT scans. Substantial hematoma growth was observed in 28% within the first hour. Of the 65 patients not undergoing surgery within 20 hours, 37% experienced hematoma growth by 20 hours. Neither baseline or peak hemodynamic parameters nor changes in hemodynamic parameters were significantly associated with hematoma growth at either 1 or 20 hours.

Conclusions--We found no blood pressure or heart rate parameters, individually or in combination, that were associated with hematoma growth. Our data suggest the influence of hemodynamic parameters on vessel wall stress to be an unlikely target for intervention in reducing the risk of early hematoma growth in ICH.

Key words: blood pressure • computed tomography • intracerebral hemorrhage

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