Dysregulated neuroendocrine stress response and blood pressure management burden are linked to remote diffusion-weighted imaging lesions after intracerebral hemorrhage: a prospective pilot study.

Remote diffusion-weighted imaging lesions (RDWILs) after intracerebral hemorrhage (ICH) are associated with unfavorable outcomes and reflect secondary microvascular injury in the setting of systemic stress responses and autonomic dysfunction due to ICH. However, association of RDWILs with neuroendocrine stress markers and acute blood pressure (BP) control remain unclear. We evaluated whether stress hormone levels and the duration of intravenous nicardipine infusion, as an index of post-ICH BP management burden, were associated with RDWILs. Patients with ICH enrolled in a prospective study (October 2020-December 2022) were analyzed. RDWILs were defined as diffusion restriction located ≥ 10 mm from the hematoma. Plasma concentrations of the hypothalamic-pituitary-adrenal (HPA) axis markers-adrenocorticotropic hormone and cortisol-and the sympathetic-adrenomedullary (SAM) axis markers-dopamine, adrenaline, noradrenaline, and urinary total metanephrine-were measured in the subacute phase. Post-ICH BP management burden was indexed by days of intravenous nicardipine required to achieve and maintain systolic BP < 140 mmHg. Among 39 patients (median age 54 years; 67% male), 7 (18%) had RDWILs. In unadjusted analyses, dysregulated HPA-axis- (lower adrenocorticotropic hormone and higher cortisol) and higher SAM-axis-related stress markers (higher dopamine, noradrenaline, and urinary total metanephrine), and longer nicardipine duration were significantly associated with RDWILs. These associations were consistent in exploratory adjusted models. Dopamine, noradrenaline, and urinary total metanephrine were also positively associated with nicardipine infusion duration. Dysregulated HPA-axis- and higher SAM-axis-related stress markers, and longer nicardipine duration were each associated with RDWILs. Higher SAM-axis-related stress markers were also associated with post-ICH BP management burden.