Perfusion CT in hyperacute cerebral hemorrhage within 3 hours after symptom onset: is there an early perihemorrhagic penumbra?

INTRODUCTION: In the recent years numerous studies have been undertaken to study cerebral perfusion in the surrounding of intracerebral hemorrhage, addressing the question of whether there is a secondary ischemic damage. Most of these studies found a reduced perfusion adjacent to the hematoma. However, the meaning of these findings remains controversial.

METHODS: We used perfusion computed tomography in 17 patients to study time to peak, cerebral blood flow, and cerebral blood volume as markers of the perihemorrhagic perfusion within 3 hours after symptom onset to search for an early difference between the extent of edema and reduced perfusion.

RESULTS: All patients showed a significant reduction of all perfusion parameters in the perihemorrhagic area, while there was no difference between the latitude of the reduced perfusion and the edema.

CONCLUSION: We did not find a difference between the extension of edema and that of restricted perfusion at a very early time point and therefore could not identify any tissue at risk of ischemia. Our findings suggest reduced perfusion and edema to have a common cause rather than presupposing one another.