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Intensive Care Medicine

, Volume 36, Issue 2, pp 264–271 | Cite as

Secondary decline of cerebral autoregulation is associated with worse outcome after intracerebral hemorrhage

  • Matthias ReinhardEmail author
  • Florian Neunhoeffer
  • Thomas A. Gerds
  • Wolf-Dirk Niesen
  • Klaus-Juergen Buttler
  • Jens Timmer
  • Bernhard Schmidt
  • Marek Czosnyka
  • Cornelius Weiller
  • Andreas Hetzel
Original

Abstract

Purpose

Blood pressure management in acute intracerebral hemorrhage (ICH) relies on functioning cerebral autoregulation. The time course of autoregulation in acute ICH and its relation with clinical outcome are not known.

Methods

Twenty-six patients with spontaneous ICH were studied on days 1, 3 and 5 after ictus. Autoregulation was noninvasively measured from spontaneous fluctuations of blood pressure and middle cerebral artery flow velocity (assessed by transcranial Doppler) using the correlation coefficient index Mx. From the same signals, non-invasive cerebral perfusion pressure was calculated. Results were compared with 55 healthy controls and related with clinical and radiological factors and 90-day outcome (modified Rankin scale).

Results

Average Mx values of all patients did not differ across days or from controls. Higher Mx (i.e., poorer autoregulation) on day 5 was significantly related with lower Glasgow coma score, ventricular hemorrhage (both sides) and lower noninvasive cerebral perfusion pressure (ipsilateral). Increasing ipsilateral Mx between days 3 and 5 was related with lower Glasgow coma score and ventricular hemorrhage. In a multivariate analysis controlling for other hemodynamic factors, higher ipsilateral Mx on day 5 (p = 0.013) was a significant predictor for poor 90-day outcome.

Conclusions

Cerebral autoregulation is primarily preserved in acute ICH, but a secondary decline mainly ipsilateral to the ICH can occur. This is associated with poor clinical status, ventricular hemorrhage, lower cerebral perfusion pressure and worse clinical outcome.

Keywords

Cerebral autoregulation Spontaneous intracerebral hemorrhage Transcranial Doppler sonography 

Notes

Acknowledgments

M.R. acknowledges support from the Deutsche Forschungsgemeinschaft (He 1949/4-1 and Ti 315/4-2).

Conflict of interest statement

There are no conflicts of interest.

Supplementary material

134_2009_1698_MOESM1_ESM.doc (26 kb)
Supplementary material (DOC 26 kb)

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Copyright information

© Copyright jointly hold by Springer and ESICM 2009

Authors and Affiliations

  • Matthias Reinhard
    • 1
    Email author
  • Florian Neunhoeffer
    • 1
  • Thomas A. Gerds
    • 3
  • Wolf-Dirk Niesen
    • 1
  • Klaus-Juergen Buttler
    • 2
  • Jens Timmer
    • 4
    • 5
  • Bernhard Schmidt
    • 6
  • Marek Czosnyka
    • 7
  • Cornelius Weiller
    • 1
  • Andreas Hetzel
    • 1
  1. 1.Department of Neurology, NeurocenterUniversity of FreiburgFreiburgGermany
  2. 2.Department of Neurosurgery, NeurocenterUniversity of FreiburgFreiburgGermany
  3. 3.Department of BiostatisticsUniversity of CopenhagenCopenhagenDenmark
  4. 4.Center for Data Analysis and ModelingUniversity of FreiburgFreiburgGermany
  5. 5.Freiburg Institute for Advanced Studies (FRIAS)University of FreiburgFreiburgGermany
  6. 6.Department of NeurologyMedical Center ChemnitzChemnitzGermany
  7. 7.Academic Neurosurgery Unit, Department of NeurosciencesUniversity of CambridgeCambridgeUK

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