Hematoma volume is a predictive factor of disturbed autoregulation after spontaneous intracerebral hemorrhage

Background: Dynamic cerebral autoregulation (dCA) is probably disturbed after spontaneous intracerebral hemorrhage (ICH) and could be an independent predictor of clinical outcome. Clinical determinants of dCA status after ICH need to be further elucidated.

Methods: We finally enrolled 53 patients diagnosed with supratentorial ICH within 6days from onset. DCA was assessed 4-6days after ICH onset by monitoring middle cerebral artery blood flow velocities and simultaneous arterial blood pressure continuously, utilizing transcranial Doppler combined with a servo-controlled finger plethysmograph. Cerebral autoregulation was evaluated by phase difference (PD) in low frequency (0.06-0.12Hz) range derived from transfer function analysis. The previous clinical history was collected including hypertension, diabetes mellitus, prior stroke, smoking, heavy drinking history. Laboratory results during hospitalization were utilized for further risk factors screening, including fasting blood glucose, glycosylated hemoglobin A (1C), total cholesterol, low density lipoprotein cholesterol and homocysteine, etc. Computed tomography scans were performed to collect neuroimaging data, including hematoma location, volume and presence of intraventricular hemorrhage. Univariate and multivariate linear analyses were adopted to explore the relationship between clinical and laboratory variables and bilateral PD respectively.

Results: In ICH patients, PD was lower (indicating disturbed autoregulation) both on the ipsilateral (37.53±17.78 degree, P<0.001) and contralateral (34.45±14.92 degree, P<0.001) side of hematoma compared with healthy controls (56.13±16.11 degree). Hematoma volume was independently associated with ipsilateral PD according to multivariate analysis (β=-0.383, P=0.024) after adjustment for clinical and laboratory factors.

Conclusions: DCA is bilaterally disturbed after supratentorial ICH. Larger hematoma volume is likely to independently predict poorer cerebral autoregulation status ipsilateral to hematoma.