Abstract WP228: Neuroendocrine Activation and Blood Pressure Control Are Linked to Remote DWI Lesions After Intracerebral Hemorrhage

Background and Purpose: Remote diffusion-weighted imaging lesions (RDWILs) after intracerebral hemorrhage (ICH) are common and predict poor outcomes. RDWILs are hypothesized to arise from early blood pressure (BP) surges/variability, inflammation, and procoagulant shifts driven by stress-system activation—the sympathetic-adrenomedullary (SAM) axis releasing catecholamines and the hypothalamic–pituitary–adrenal (HPA) axis releasing cortisol. We therefore tested three hypotheses: (1) SAM/HPA activity is associated with RDWILs; (2) the duration of intravenous nicardipine as an index of post-ICH BP control is associated with RDWILs; and (3) SAM/HPA activity is associated with nicardipine duration. Methods: Consecutive patients with ICH who participated in our prospective pilot study to evaluate endocrine profile were enrolled from October 2020 to December 2022. RDWILs were defined as high signal on DWI while low signal on ADC, located ≥10 mm from the hematoma. Plasma concentrations of the HPA-axis markers—adrenocorticotropic hormone (ACTH) and cortisol—and the SAM-axis markers—dopamine, adrenaline, and noradrenaline—were measured as stress markers after transfer from the SCU to the general ward to reduce environmental stress. Post-ICH BP control was assessed using the number of days of intravenous nicardipine needed to achieve and maintain the target systolic BP