Background and Purpose: Remote diffusion-weighted imaging lesions (RDWILs) after intracerebral hemorrhage (ICH) are common and predict poor outcomes. RDWILs are hypothesized to arise from early blood pressure (BP) surges/variability, inflammation, and procoagulant shifts driven by stress-system activation—the sympathetic-adrenomedullary (SAM) axis releasing catecholamines and the hypothalamic–pituitary–adrenal (HPA) axis releasing cortisol. We therefore tested three hypotheses: (1) SAM/HPA activity is associated with RDWILs; (2) the duration of intravenous nicardipine as an index of post-ICH BP control is associated with RDWILs; and (3) SAM/HPA activity is associated with nicardipine duration. Methods: Consecutive patients with ICH who participated in our prospective pilot study to evaluate endocrine profile were enrolled from October 2020 to December 2022. RDWILs were defined as high signal on DWI while low signal on ADC, located ≥10 mm from the hematoma. Plasma concentrations of the HPA-axis markers—adrenocorticotropic hormone (ACTH) and cortisol—and the SAM-axis markers—dopamine, adrenaline, and noradrenaline—were measured as stress markers after transfer from the SCU to the general ward to reduce environmental stress. Post-ICH BP control was assessed using the number of days of intravenous nicardipine needed to achieve and maintain the target systolic BP<140 mmHg, during which nicardipine was gradually tapered while patients were transitioned to oral antihypertensives. Results: We included 39 patients with ICH (26 67% male, median age 54 years). Of these, RDWILs were detected in 7 (18%) cases (Figure 1). In Poisson regression analysis with a robust variance estimator, both HPA-axis activation (low ACTH and high cortisol) and SAM-axis activation (high dopamine and noradrenaline) were associated with RDWILs in all models ( p < 0.05, Figure 2). Next, nicardipine administration lengths may also be related to RDWILs in the same models ( p < 0.05, Figure 2). Finally, dopamine and noradrenaline demonstrated significant positive correlations with the length of nicardipine administration in multiple models ( p < 0.05, Figure 3). Conclusions: Activation of HPA- and SAM-axis, and longer duration of intravenous nicardipine were each associated with RDWILs; moreover, SAM-axis activation was related to longer nicardipine infusion. These findings suggest that autonomic and neuroendocrine dysregulation may contribute to the development of RDWILs after ICH.
Okumura et al. (Thu,) studied this question.
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