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(Stroke. 2009;40:1638.)
© 2009 American Heart Association, Inc.

Original Contributions

Transient Focal Increase in Perihematomal Glucose Metabolism After Acute Human Intracerebral Hemorrhage

Allyson R. Zazulia, MD; Tom O. Videen, PhD William J. Powers, MD

From the Departments of Neurology and Neurological Surgery (A.R.Z., T.O.V., W.J.P.) and Radiology (A.R.Z., T.O.V., W.J.P.), Washington University, St. Louis, Mo; and the Department of Neurology (W.J.P.), University of North Carolina, Chapel Hill.

Correspondence to Allyson Zazulia, MD, Department of Neurology, Washington University School of Medicine, 660 S Euclid Avenue, Campus Box 8111, St. Louis, MO 63110. E-mail zazuliaa{at}neuro.wustl.edu

Background and Purpose— Progressive perihematomal cell death over 3 to 4 days has been described after experimental intracerebral hemorrhage (ICH). We investigated whether progressive perihematomal damage occurs in human subjects by measuring relative changes in regional cerebral glucose metabolism with ¹⁸F-fluorordeoxyglucose (FDG) positron emission tomography at multiple time points during the first week after ICH.

Methods— Thirteen subjects with a median hematoma volume of 22 cm³ were studied 1.0±0.3, 2.9±0.8, and 6.7±1.6 days after ICH. Normalized mean counts in 5 concentric annular 2-mm-thick perihematomal volumes-of-interest (VOIs) were compared to the initial study. Next, automated searches with 0.5 to 5.0 mL spherical VOIs identified maximum focal changes in normalized counts compared to the initial study.

Results— No annular or focal decrease in perihematomal FDG uptake developed. Instead, FDG uptake significantly increased at session #2 in the first 3 2-mm annular VOIs (9.2%±14.2, 7.8%±11.3, 5.9%±9.0), returning to baseline at session #3. The VOI search identified focal regions of increased perihematomal FDG uptake relative to the contralateral control hemispheres in 6 subjects, which accounted for the annular increase.

Conclusion— Perihematomal glucose metabolism increased transiently in a subset of patients 2 to 4 days after acute ICH. These transient focal increases in glucose metabolism occurring in the brain after acute ICH demonstrate that there are ongoing processes in response to injury that last for days. Although further studies are needed to elucidate their pathophysiology, these processes may be indicative of a prolonged window for intervention to improve neurological outcome.

Key Words: intracerebral hemorrhage • glucose metabolism • fluorodeoxyglucose • positron emission tomography

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