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

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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.

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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.

Author information

Authors and Affiliations

  1. Department of Neurology, Neurocenter, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany

    Matthias Reinhard, Florian Neunhoeffer, Wolf-Dirk Niesen, Cornelius Weiller & Andreas Hetzel

  2. Department of Neurosurgery, Neurocenter, University of Freiburg, Freiburg, Germany

    Klaus-Juergen Buttler

  3. Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark

    Thomas A. Gerds

  4. Center for Data Analysis and Modeling, University of Freiburg, Freiburg, Germany

    Jens Timmer

  5. Freiburg Institute for Advanced Studies (FRIAS), University of Freiburg, Freiburg, Germany

    Jens Timmer

  6. Department of Neurology, Medical Center Chemnitz, Chemnitz, Germany

    Bernhard Schmidt

  7. Academic Neurosurgery Unit, Department of Neurosciences, University of Cambridge, Cambridge, UK

    Marek Czosnyka

Authors
  1. Matthias Reinhard
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  2. Florian Neunhoeffer
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  7. Bernhard Schmidt
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  10. Andreas Hetzel
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Correspondence to Matthias Reinhard.

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Reinhard, M., Neunhoeffer, F., Gerds, T.A. et al. Secondary decline of cerebral autoregulation is associated with worse outcome after intracerebral hemorrhage. Intensive Care Med 36, 264–271 (2010). https://doi.org/10.1007/s00134-009-1698-7

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  • DOI: https://doi.org/10.1007/s00134-009-1698-7

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