Abstract TP310: Subarachnoid Extension of Intracerebral Hemorrhage and Perihematomal Ischemic Compression Are Related, Harmful Processes
Background: Decreased diffusion is associated with poor outcomes in primary intracerebral hemorrhage (ICH), although the mechanism of that phenomenon is uncertain. Two distinct types of decreased diffusion have been observed, perihematomal ischemia (PHI) and distant areas of ischemia. Extension of hemorrhage into the subarachnoid (SAH) and intraventricular (IVH) compartments may be indicators of high perihematomal pressures and diminished brain parenchyma compliance. The objective of this study is to evaluate for an association between PHI and poor outcomes, and to evaluate whether PHI is associated with SAH and IVH as markers of injurious perihematomal pressure.
Methods: Patients with primary ICH were enrolled into a prospective registry between December 2006 and July 2012. Patients were managed, and serial neuroimaging obtained, per a structured protocol. MRI was performed on all salvageable patients when possible. SAH, IVH and PHI were identified on imaging, along with ICH volumes, by expert reviewers blinded to outcomes. An ordinal regression model was used to evaluate for an association between PHI and modified Rankin Scale (mRS) at 28 days, adjusted for ICH Score. A binary logistic regression models was developed to identify an association between PHI and other potential predictors of malignant peri-hematomal pressures: SAH, IVH, initial hematoma volume, and supra- versus infratentorial location.
Results: 94 patients were studied. 27 (28.7%) had SAH and 44 (46.8%) had IVH. PHI was associated with mRS at 28 days (odds ratio 2.88 [95% CI 1.23-6.75]), independent of ICH Score. PHI was associated with SAH (3.74 [1.25-11.21]), whereas no significant association was found with IVH, hematoma volume or location.
Conclusions: PHI is independently associated with poor outcomes in primary ICH. PHI is associated with SAH, but not hemorrhage volume, location or decompression into the ventricular system. These findings suggest that PHI and subarachnoid hemorrhage extension are associated, unique markers for injurious perihematomal pressure.
- © 2012 by American Heart Association, Inc.