Abstract 102: High Rate of Silent Ischemic Lesions at 1 Year in Patients with Primary Intracerebral Hemorrhage
Background: We have previously reported that approximately one-third of patients with primary intracerebral hemorrhage (ICH) have acute ischemic lesions remote from the hematoma on baseline and day 30 MR imaging. The objective of the current analysis was to determine the prevalence, characteristics, and associated risk factors for concurrent silent ischemic lesions at 1 year in a predominantly black, hypertensive ICH population. The analysis was undertaken as part of a prospective, multicenter, MRI-based, longitudinal natural history study of racial differences in patients with primary ICH.
Methods: Inclusion criteria were: primary ICH, age ≥ 18, baseline and 1 year MRI scan obtained. Clinical and demographic data were collected on all subjects. A standardized MRI protocol was employed and included DWI (with apparent diffusion coefficient [ADC] maps), T2*-weighted image sequences (GRE), and FLAIR sequences. Images were evaluated for: location and volume of the primary hematoma, frequency and location of ischemic lesions, frequency and location of microbleeds, and white matter disease severity. DWI lesions were categorized as acute or subacute based on ADC maps.
Results: Of the 104 patients with 1 year MRIs, mean age was 58 years, 55% were male, 76% black, and 87% had a history of hypertension. Primary hematoma location was deep in 77% of subjects and lobar in 23%. Mean baseline NIHSS was 8 (median 5). Mean baseline ICH volume was 20 cc (median 13 cc). DWI ischemic lesions were found in 18 (17%) subjects. Fifteen subjects had 1 lesion and 3 had 2 lesions. Of the total 21 lesions, 12 (57%) were acute (low ADC), and 9 (43%) were subacute. Nine (43%) lesions were located in lobar locations, and 12 (57%) were in deep structures. On univariate analysis, age, hypertension, prior stroke, microbleed burden, leukoaraiosis, antiplatelet use at 1 year, and mean arterial pressure at 1 year were not significantly associated with presence of DWI lesions.
Conclusions: In this longitudinal MR imaging study of ICH, we found that 17% of subjects had evidence of ongoing silent ischemia on diffusion-weighted imaging at 1 year. This finding further supports the active nature of the underlying vasculopathy. A larger cohort is needed to identify risk factors for and/or imaging characteristics predictive of ischemic lesions. These lesions may be an important biomarker for future risk factor control.
- © 2012 by American Heart Association, Inc.