Associations of acute cerebral infarction after spontaneous intracerebral hemorrhage with white matter lesions, cerebral artery stenosis and blood pressure variability

Abstract

Objective To study the associations of acute cerebral infarction after spontaneous intracerebral hemorrhage (ICH) with white matter lesions (WMLs), cerebral artery stenosis and blood pressure (BP) variability. Methods One hundred and fifty-five acute ICH patients, consecutive hospitalized within 24 h of onset from March 2012 to September 2015, were chosen; they were divided into infarction after ICH group and non-infarction after ICH group according to hyperintensities remote from the hematoma by magnetic resonance diffusion-weighted imaging (DWI) within 4 weeks of onset; according to positions of hemorrhage, they were divided into lobar hemorrhage group and non-lobar hemorrhage group; according to reduction range of mean arterial pressure (MAP) one h within admission, they were divided into intensive BP lowering group (MAP lowering by ≥20% ) and non-intensive BP lowering group (MAP lowering<20%). The clinical and radiological characteristics were analyzed to investigate the role of WMLs, cerebral artery stenosis and BP variability in acute cerebral infarction after spontaneous ICH. Results Ischemic infarcts were detected in 36 of 155 patients (23.2%), mostly located at ipsilateral subcortical cortex; 80.6% of them were asymptomatic infarct and 66.7% of them were lacunar infarcts. Positions of hemorrhage and severity of leukoaraiosis were significantly different between infarction after ICH group and non-infarction after ICH group (P 0.05). Stratified analysis showed that leukoaraiosis in patients from infarction after lobar ICH group was significantly severer than that in those from non-infarction after lobar ICH group (P<0.05), and the cerebral artery stenosis in patients with infarction after non-lobar ICH was significantly severer than that in those with non-infarction after non-lobar ICH (P<0.05). Intensive BP lowering patients with cerebral artery stenosis ≥50% group had significantly increased risks of acute ischemic infarcts as compared with intensive BP lowering patients with cerebral artery stenosis<50% group, non-intensive BP lowering patients with cerebral artery stenosis ≥50% group, and non-intensive BP lowering patients with cerebral artery stenosis<50% group, respectively (P<0.05). Multivariate Logistic regression analysis showed that lobar hemorrhage and moderate to severe leukoaraiosis were independent risk factors of cerebral infarction after ICH (OR= 2.484, 95% CI: 1.037-5.953, P=0.041; OR=2.426, 95% CI: 1.045-5.629, P=0.039). Conclusion Cerebral infarction after ICH is mainly associated with cerebral small vessel diseases, intensive BP lowering is associated with high risk of acute ischemic infarcts in patients with atherosclerotic large artery stenosis, and individualized BP control may maximumly reduce secondary brain injury after ICH. Key words: Intracerebral hemorrhage; Cerebral infarction; White matter lesion; Cerebral artery stenosis; Blood pressure variability