Abstract
Background and Objectives: Acute DWI lesions are frequently found in patients with intracerebral hemorrhage (ICH). We aim to identify whether these patients have a higher risk of death, recurrent ICH or ischemic stroke compared to those without DWI positive lesions. Methods: We identified 214 prospectively enrolled patients with acute ICH admitted to Massachusetts General Hospital from January 2005 to September 2011 who underwent brain MRI within 7 days. The presence of cardiovascular death, ICH or ischemic stroke was compared between patients according to the presence and number of DWI lesions (absent, single or multiple). Results: Mean age was 74 years and 52% were female. Of the 214 patients, 41 had acute DWI lesions (25 single and 16 multiple). The rates of hypertension, diabetes, atrial fibrillation and coronary artery disease did not differ between groups. Most patients were diagnosed with probable cerebral amyloid angiopathy (60%) and had a lobar location (66%). The mean follow-up time was 2686 days. Patients with single or multiple DWI lesions tended to have higher rates of recurrent intracerebral hemorrhages, vascular death and ischemic strokes compared to the DWI negative group (multiple=56.2% vs. single=20% vs. absent=20.8%, p=0.005). In multivariate analysis using age, gender, DWI lesions, ICH volume, and ICH etiology as covariates, DWI lesions remained an independent predictor of recurrent ICH, vascular death or ischemic stroke. Conclusion: The presence of acute DWI lesions in ICH patients confers a higher risk of the composite outcome recurrent intracerebral hemorrhage, vascular death and ischemic stroke.
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