Remote diffusion-weighted imaging lesions and blood pressure variability in primary intracerebral hemorrhage

Abstract

ObjectiveThe aim of this study was to examine the association between remote diffusion-weighted imaging lesions (R-DWILs) and blood pressure variability (BPV) in patients with primary intracerebral hemorrhage (ICH).MethodsWe conducted a retrospective review of a consecutive cohort of 375 patients with primary ICH within 24 h onset. R-DWILs were defined as hyperintensity lesions in DWI remote from the hematoma. Blood pressure recordings were extracted up to 24 h post-admission. BPV was measured using SD, coefficient of variation (CV), and successive variation (SV).ResultsRemote DWI lesions were detected in 65 (17.3%) primary ICH patients. In multivariable logistic regression analysis, parameters of BPV were independently associated with R-DWILs, and the results remained consistent after being adjusted with mean SBP. SD, CV, and SV values in the highest quintile, showed 3- to 8-fold increased risk of R-DWILs, compared with the lowest quintile. ΔSBP demonstrated a significant difference in 2 different predictive models. Max SBP only dictated a significant difference in model 1. Mean SBP, admission SBP, and min SBP, failed to present an association with R-DWILs in model 1 or model 2.ConclusionOur results provided additional evidence that BPV is associated with the development of R-DWILs in primary ICH.

Neuro-imaging in intracerebral hemorrhage: updates and knowledge gaps

“…Studies have shown a correlation between aggressive blood pressure reduction, systolic blood pressure variability, and the occurrence of DWI MRI lesions, suggesting that acute disruptions in blood pressure autoregulation may contribute to their development ( Kidwell et al, 2017 ). These lesions have been associated with conditions such as SVD and CAA, and their pathogenesis may involve additional factors related to microangiopathy and characteristics specific to ICH ( Wu et al, 2015 ; Murthy et al, 2020 ; Xu et al, 2022 ) Despite being often subclinical and unidentifiable on CT, the presence of punctate ischemic DWI lesions increases the risk of subsequent ischemic stroke by 2.5 times, and may be associated with worse long-term outcomes ( Murthy et al, 2021 ). Identifying these DWI lesions through MRI could provide valuable insight for stratifying patients based on potential outcomes, and could even guide acute blood pressure targets, highlighting the utility of MRI in assessing patient prognosis.…”