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Association Between Perihematomal Perfusion and Intracerebral Hemorrhage Outcome

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The prognostic impact of perihematomal hypoperfusion in patients with acute intracerebral hemorrhage (ICH) remains unclear. We tested the hypothesis that perihematomal hypoperfusion predicts poor ICH outcome and explored whether hematoma growth (HG) is the pathophysiological mechanism behind this association.


A prospectively collected single-center cohort of consecutive ICH patients undergoing computed tomography perfusion on admission was analyzed. Cerebral blood flow (pCBF) was measured in the manually outlined perihematomal low-density area. pCBF was categorized into normal (40–55 mL/100 g/min), low (< 40 mL/100 g/min), and high (> 55 mL/100 g/min). HG was calculated as total volume increase from baseline to follow-up CT. A modified Rankin scale > 2 at three months was the outcome of interest. The association between cerebral perfusion and outcome was investigated with logistic regression, and potential mediators of this relationship were explored with mediation analysis.


A total of 155 subjects were included, of whom 55 (35.5%) had poor outcome. The rates of normal pCBF, low pCBF, and high pCBF were 17.4%, 68.4%, and 14.2%, respectively. After adjustment for confounders and keeping subjects with normal pCBF as reference, the risk of poor outcome was increased in patients with pCBF < 40 mL/100 g/min (odds ratio 6.11, 95% confidence interval 1.09–34.35, p = 0.040). HG was inversely correlated with pCBF (R = −0.292, p < 0.001) and mediated part of the association between pCBF and outcome (proportion mediated: 82%, p = 0.014).


Reduced pCBF is associated with poor ICH outcome in patients with mild-moderate severity. HG appears a plausible biological mediator but does not fully account for this association, and other mechanisms might be involved.

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Author information

GB, AB, IC, and EF contributed to data acquisition. AM and SM contributed to statistical analysis. AM and EF contributed to manuscript drafting. AM, GB, AB, SM, IC, and EF contributed to critical revision. EF contributed to study supervision.

Correspondence to Andrea Morotti.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Institutional Review Board of the Azienda Ospedaliera Universitaria, Arcispedale S. Anna, Ferrara, Italy, approved this study. Informed consent was obtained from each patient or close relatives.

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Morotti, A., Busto, G., Bernardoni, A. et al. Association Between Perihematomal Perfusion and Intracerebral Hemorrhage Outcome. Neurocrit Care (2020). https://doi.org/10.1007/s12028-020-00929-z

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  • Intracerebral hemorrhage
  • Cerebral blood flow
  • CT perfusion
  • Outcome
  • Stroke