Acute punctate ischemic lesions, as observed on diffusion-weighted imaging (DWI), occur in more than one-third of patients with primary intracerebral hemorrhage (ICH).1 Spatially, the lesions may be located in the surrounding vicinity of the acute hematoma or may be distant and even on the contralateral side from the hematoma.1 Several studies have found consistent associations between DWI lesions and initial ICH volume, blood pressure elevations or changes in the first 24 hours, and the presence of cerebral small vessel disease, but the exact mechanism has yet to be discerned.2,3 Nevertheless, the presence of a DWI lesion portends poor outcome after ICH and is independently associated with severe disability and death.2,3 Therefore, factors potentiating these lesions could theoretically worsen clinical outcomes.
Oh SE, Murthy SB. Tranexamic Acid and Diffusion-Weighted Imaging Lesions After Intracerebral Hemorrhage. JAMA Neurol. 2022;79(5):447–449. doi:10.1001/jamaneurol.2022.0228
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