• Björn M Hansen, Natalie Ullman, John Muschelli, Bo Norrving, Rachel Dlugash, Radhika Avadhani, Issam Awad, Mario Zuccarello, Wendy C Ziai, Daniel F Hanley, Richard E Thompson, Arne Lindgren, and MISTIE and CLEAR Investigators.
• Department of Clinical Sciences Lund, Neurology, Skåne University Hospital, Lund University, Lund, Sweden.
• Neurocrit Care. 2020 Oct 1; 33 (2): 516-524.

Background/ObjectiveIntracerebral hemorrhage (ICH) patients commonly have concomitant white matter lesions (WML) which may be associated with poor outcome. We studied if WML affects hematoma expansion (HE) and post-stroke functional outcome in a post hoc analysis of patients from randomized controlled trials.MethodsIn ICH patients from the clinical trials MISTIE II and CLEAR III, WML grade on diagnostic computed tomography (dCT) scan (dCT, < 24 h after ictus) was assessed using the van Swieten scale (vSS, range 0-4). The primary outcome for HE was > 33% or > 6 mL ICH volume increase from dCT to the last pre-randomization CT (< 72 h of dCT). Secondary HE outcomes were: absolute ICH expansion, > 10.4 mL total clot volume increase, and a subgroup analysis including patients with dCT < 6 h after ictus using the primary HE definition of > 33% or > 6 mL ICH volume increase. Poor functional outcome was assessed at 180 days and defined as modified Rankin Scale (mRS) ≥ 4, with ordinal mRS as a secondary endpoint.ResultsOf 635 patients, 55% had WML grade 1-4 at dCT (median 2.2 h from ictus) and 13% had subsequent HE. WML at dCT did not increase the odds for primary or secondary HE endpoints (P ≥ 0.05) after adjustment for ICH volume, intraventricular hemorrhage volume, warfarin/INR > 1.5, ictus to dCT time in hours, age, diabetes mellitus, and thalamic ICH location. WML increased the odds for having poor functional outcome (mRS ≥ 4) in univariate analyses (vSS 4; OR 4.16; 95% CI 2.54-6.83; P < 0.001) which persisted in multivariable analyses after adjustment for HE and other outcome risk factors.ConclusionsConcomitant WML does not increase the odds for HE in patients with ICH but increases the odds for poor functional outcome.Clinical Trial Registrationhttp://www.clinicaltrials.gov trial-identifiers: NCT00224770 and NCT00784134.

14 keywords...

hide…