Predictors of highly prevalent brain ischemia in intracerebral hemorrhage

Objective: This study was undertaken to determine the prevalence, characteristics, risk factors, and temporal profile of concurrent ischemic lesions in patients with acute primary intracerebral hemorrhage (ICH). Methods: Patients were recruited within a prospective, longitudinal, magnetic resonance imaging (MRI)‐based study of primary ICH. Clinical, demographic, and MRI data were collected on all subjects at baseline and 1 month. Results: Of the 138 patients enrolled, mean age was 59 years, 54% were male, 73% were black, and 84% had a history of hypertension. At baseline, ischemic lesions on diffusion‐weighted imaging (DWI) were found in 35% of patients. At 1 month, lesions were present in 27%, and of these lesions, 83% were new and not present at baseline. ICH volume ( p = 0.025), intraventricular hemorrhage ( p = 0.019), presence of microbleeds ( p = 0.024), and large, early reductions in mean arterial pressure ( p = 0.003) were independent predictors of baseline DWI lesions. A multivariate logistical model predicting the presence of 1‐month DWI lesions included history of any prior stroke ( p = 0.012), presence of 1 or more microbleeds ( p = 0.04), black race ( p = 0.641), and presence of a DWI lesion at baseline ( p = 0.007). Interpretation: This study demonstrates that >⅓ of patients with primary ICH have active cerebral ischemia at baseline remote from the index hematoma, and ¼ of patients experience ongoing, acute ischemic events at 1 month. Multivariate analyses implicate blood pressure reductions in the setting of an active vasculopathy as a potential underlying mechanism. Further studies are needed to determine the impact of these lesions on outcome and optimal management strategies to arrest vascular damage. Ann Neurol 2012;71:199–205