Hypoperfusion and its augmentation in patients with brain ischemia |
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Authors: | Robert J Wityk Lucas Restrepo |
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Institution: | (1) Department of Neurology and Medicine, Johns Hopkins University School of Medicine, Meyer 5-181, 600 N. Wolfe Street, 21287 Baltimore, MD, USA |
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Abstract: | Opinion statement Control of hypertension is a well-established goal of the primary and secondary prevention of stroke. However, management
of blood pressure in the setting of acute brain ischemia is complicated by the possible effect of blood pressure changes on
cerebral perfusion. In acute stroke, patients may have an ischemic penumbra of brain tissue, which has impaired perfusion
but which is not irreversibly damaged. The ischemic penumbra may be salvaged with reperfusion. Lowering of blood pressure
in this setting, however, would hasten the progression of the penumbra to infarction. With the exception of patients treated
with thrombolytic agents, blood pressure reduction is not recommended in acute ischemic stroke for this reason. Preliminary
studies suggest that there may be a role for interventions to elevate blood pressure as a treatment for acute stroke patients.
Despite interest in induced hypertension as a treatment of stroke dating back to the 1950s, this practice has not achieved
widespread use owing to concerns about potential adverse effects such as intracerebral hemorrhage, cerebral edema, and myocardial
ischemia. It is commonly used, however, to treat patients with threatened cerebral ischemia due to vasospasm after subarachnoid
hemorrhage. Until future studies clarify the effectiveness of induced hypertension in stroke treatment, maintaining adequate
blood pressure and fluid volume is recommended for patients with acute ischemic stroke, particularly if the neurologic deficits
are fluctuating or the patient has persistent large-vessel occlusive disease. |
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