Response to Letter by Nishikawa Regarding Article, “Blood Pressure Reduction, Decreased Diffusion on MRI, and Outcomes After Intracerebral Hemorrhage”

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HomeStrokeVol. 43, No. 1Response to Letter by Nishikawa Regarding Article, “Blood Pressure Reduction, Decreased Diffusion on MRI, and Outcomes After Intracerebral Hemorrhage” Free AccessReplyPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReplyPDF/EPUBResponse to Letter by Nishikawa Regarding Article, “Blood Pressure Reduction, Decreased Diffusion on MRI, and Outcomes After Intracerebral Hemorrhage” Andrew M. Naidech, MD, MSPH, Matthew B. Maas, MD, Alexander J. Nemeth, MD and Eric J. Russell, MD Andrew M. NaidechAndrew M. Naidech Northwestern University Feinberg School of Medicine Chicago, IL (Naidech, Maas, Nemeth, Russell) Search for more papers by this author , Matthew B. MaasMatthew B. Maas Northwestern University Feinberg School of Medicine Chicago, IL (Naidech, Maas, Nemeth, Russell) Search for more papers by this author , Alexander J. NemethAlexander J. Nemeth Northwestern University Feinberg School of Medicine Chicago, IL (Naidech, Maas, Nemeth, Russell) Search for more papers by this author and Eric J. RussellEric J. Russell Northwestern University Feinberg School of Medicine Chicago, IL (Naidech, Maas, Nemeth, Russell) Search for more papers by this author Originally published15 Dec 2011https://doi.org/10.1161/STROKEAHA.111.643007Stroke. 2012;43:e15Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: January 1, 2011: Previous Version 1 Response:Nishikawa1 notes that we found a high incidence of decreased diffusion (DD) in patients with intracerebral hemorrhage compared with other studies. We are glad that he agrees, and his unpublished data confirm, that whether DD is common is not the issue, but rather, how common it is. A few methodological differences may account for the differences between cohorts. Patients in the sample reported by the Massachusetts General Hospital2 group were not acutely symptomatic from cerebral amyloid angiography (1 was excluded for that reason), a different population than our sample (acute intracerebral hemorrhage generally from amyloid angiopathy or hypertension). In the cohort from our colleagues across town at Rush,3 MRI scans were interpreted by stroke neurologists; perhaps neuroradiologists are more sensitive, although the interrater reliability for assessing DD is high, as we noted. A multicenter European study that was not yet published at the time that we submitted our work also documented DD after intracerebral hemorrhage,4 although not all of the patients were scanned acutely (some >2 months from symptom onset), as opposed to our cohort. We stand by our methods of scanning soon after symptom onset and meticulous MRI interpretation by experts. The confirmation of acute blood pressure reduction as a clinical risk factor for DD and its impact on 3-month functional outcomes in multivariate models underscore its importance as a subject for future research.Andrew M. Naidech, MD, MSPHMatthew B. Maas, MDAlexander J. Nemeth, MDEric J. Russell, MD Northwestern University Feinberg School of Medicine Chicago, ILDisclosuresNone.FootnotesStroke welcomes Letters to the Editor and will publish them, if suitable, as space permits. Letters must reference a Stroke published-ahead-of-print article or an article printed within the past 3 weeks. The maximum length is 750 words including no more than 5 references and 3 authors. Please submit letters typed double-spaced. Letters may be shortened or edited. Include a completed copyright transfer agreement form (available online at http://stroke.ahajournals.org and http://submit-stroke.ahajournals.org).