• Eur. J. Clin. Invest. · Apr 2022

    Delayed perihematomal hypoperfusion is associated with poor outcome in intracerebral haemorrhage.

    • Andrea Morotti, Giorgio Busto, Gregoire Boulouis, Elisa Scola, Andrea Bernardoni, Alessandro Fiorenza, Tommaso Amadori, Federico Carbone, Ilaria Casetta, Fabrizio Montecucco, and Enrico Fainardi.
    • Neurology Unit, Department of Neurological Sciences and Vision, ASST-Spedali Civili, Brescia, Italy.
    • Eur. J. Clin. Invest. 2022 Apr 1; 52 (4): e13696.

    BackgroundThe aim of this study was to characterize the temporal evolution and prognostic significance of perihematomal perfusion in acute intracerebral haemorrhage (ICH).MethodsA single-centre prospective cohort of patients with primary spontaneous ICH receives computed tomography perfusion (CTP) within 6 h from onset (T0) and at 7 days (T7). Cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) were measured in the manually outlined perihematomal low-density area. Poor functional prognosis (modified Rankin Scale 3-6) at 90 days was the outcome of interest, and predictors were explored with multivariable logistic regression.ResultsA total of 150 patients were studied, of whom 52 (34.7%) had a mRS 3-6 at 90 days. Perihematomal perfusion decreased from T0 to T7 in all patients, but the magnitude of CBF and CBV reduction was larger in patients with unfavourable outcome (median CBF change -7.8 vs. -6.0 ml/100 g/min, p < .001, and median CBV change -0.5 vs. -0.4 ml/100 g, p = .010, respectively). This finding remained significant after adjustment for confounders (odds ratio [OR] for 1 ml/100 g/min CBF reduction: 1.33, 95% confidence interval [CI] (1.15-1.55), p < .001; OR for 0.1 ml/100 g CBV reduction: 1.67, 95% CI 1.18-2.35, p = .004). The presence of CBF < 20 ml/100 g/min at T7 was then demonstrated as an independent predictor of poor functional outcome (adjusted OR: 2.45, 95% CI 1.08-5-54, p = .032).ConclusionPerihaemorrhagic hypoperfusion becomes more severe in the days following acute ICH and is independently associated with poorer outcome. Understanding the underlying biological mechanisms responsible for delayed decrease in perihematomal perfusion is a necessary step towards outcome improvement in patients with ICH.© 2021 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.

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