Predictors of highly prevalent brain ischemia in intracerebral hemorrhage.
Predictors of highly prevalent brain ischemia in intracerebral hemorrhage.
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DOI：
10.1002/ana.22668
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发表时间：
2012-02
影响因子：
11.2
通讯作者：
Kidwell, Chelsea S.
中科院分区：
文献类型：
--
作者：
Menon, Ravi S.;Burgess, Richard E.;Wing, Jeffrey J.;Gibbons, M. Christopher;Shara, Nawar M.;Fernandez, Stephen;Jayam-Trouth, Annapurni;German, Laura;Sobotka, Ian;Edwards, Dorothy;Kidwell, Chelsea S.
确定急性原发性脑出血（ICH）患者并发缺血性病变的患病率、特征、危险因素和时间特征。在一项基于原发性ICH的前瞻性、纵向、磁共振成像（MRI）研究中招募患者。在基线和1个月时收集所有受试者的临床、人口统计学和MRI数据。在入组的138例患者中，平均年龄为59岁，54%为男性，73%为黑人，84%有高血压病史。在基线时，35%的患者在弥散加权成像（DWI）上发现缺血性病变。在1个月时，27%的患者存在病变，其中83%为新发病变，基线时不存在。ICH体积（p=0.025）、脑室内出血（p=0.019）、微出血（p=0.024）和平均动脉压早期大幅降低（p=0.003）是基线DWI病变的独立预测因素。多变量逻辑模型预测1个月DWI病变的存在，包括任何既往卒中史（p=0.012），存在1次或多次微出血（p=0.04），黑人（p=0.641），和基线时存在DWI病变（p=0.007）该研究表明，超过1/3的原发性ICH患者在基线时存在远离指示血肿的活动性脑缺血，1/4的患者在1个月时经历持续的急性缺血事件。多变量分析表明，活动性血管病变患者的血压降低是潜在的潜在机制。需要进一步的研究来确定这些病变对预后的影响，以及阻止血管损伤的最佳治疗策略。
To determine the prevalence, characteristics, risk factors and temporal profile of concurrent ischemic lesions in patients with acute primary intracerebral hemorrhage (ICH). 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. Of the 138 patients enrolled, mean age was 59 years, 54% were male, 73% 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) This study demonstrates that more than 1/3 of patients with primary ICH have active cerebral ischemia at baseline remote from the index hematoma, and 1/4 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.
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影响因子：
9.9
作者：
Kimberly, W. T.;Gilson, A.;Greenberg, S. M.
通讯作者：
Greenberg, S. M.
影响因子：
2.9
作者：
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48
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通讯作者：
Breteler, Monique M. B.
影响因子：
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作者：
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通讯作者：
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影响因子：
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作者：
GOLDSTEIN, LB;BERTELS, C;DAVIS, JN
通讯作者：
DAVIS, JN