Abstract TMP75: Blood Brain Barrier Disruption And Neurologic Outcomes In Intracranial Hemorrhage Patients

Abstract

Introduction: Patients with primary intracerebral hemorrhage (ICH) are known to demonstrate disruption of the blood-brain barrier (BBB) particularly in peri-hematomal regions. However, disruption of the BBB may also occur throughout the brain, even in areas remote from the acute bleed. We aimed to study the clinical significance of this finding. Methods: We performed a retrospective review of our prospectively collected ICH database from January 2020 to January 2022 to identify consecutive patients who had MR perfusion study performed within 5 days from admission. BBB permeability data was analyzed blinded to the clinical data. Baseline demographics, admission systolic blood pressure and NIH stroke scale (NIHSS) score were collected during the hospitalization. A measure of whole brain BBB permeability was computed from the perfusion MR scans. Primary outcome was good neurologic outcome defined as a modified Rankin Scale (mRS) score of 0-3 at 90 days. We examined the association between the BBB permeability and clinical outcome. Results: A total of 24 ICH patients were identified. Median age was 60 years old (Interquartile range (IQR) 57-70), with 11 females (45.8%) and 13 males (54.2%). Median hematoma volume was 40.3mL (IQR 14.9-53.2mL), with a median admission NIHSS of 17.5 (IQR 15-22). Thirteen out of 24 patients achieved a good neurologic outcome at 3 months (54.2%). Patients who achieved a good neurologic outcome were more likely to have a lower admission NIHSS (16 vs 20 p=0.04), smaller baseline hematoma volume (24.6mL vs 48.4 mL), (p=0.02), and a lower NIHSS at discharge (4 vs 19), (p=0.003). Median whole brain BBB permeability was insignificantly lower in patients who achieved a better neurologic outcome (1.8 vs 2.1, p=0.17). However, a threshold of whole brain BBB permeability less than 1.9% significantly correlated with improved neurologic outcome at 3 months (Odds Ratio=0.11, 95% Confidence Interval (0.02-0.71), p=0.02). Additionally, the same threshold was significantly associated with a lower NIHSS at discharge (5 vs 17.5, p=0.03). Conclusion: Diffuse disruption of the BBB in the days after presenting with ICH is associated with worse clinical outcome if the disruption is severe.