Effects of induced hypertension on intracranial pressure and flow velocities of the middle cerebral arteries in patients with large hemispheric stroke.
OBJECTIVE
Our aim was to prospectively evaluate the effects of induced arterial hypertension in patients with large ischemic stroke.


METHODS
A total of 47 monitoring sessions in 19 patients with acute, complete, or subtotal middle cerebral artery (MCA) territory stroke were performed. Intracranial pressure (ICP) was monitored using a parenchymal catheter. Mean arterial blood pressure (MAP), ICP, and peak mean flow velocity of the middle cerebral arteries (V(m)MCA) were continuously recorded. Patients with acute ICP crises were excluded. After obtaining baseline values, MAP was raised by an infusion of norepinephrine to reach an MAP increase of at least 10 mm Hg. After MAP had reached a peak plateau level, the norepinephrine infusion was stopped.


RESULTS
Baseline MAP was 83.6+/-1.6 mm Hg and rose to 108.9+/-2.0 mm Hg after infusion of norepinephrine. ICP slightly increased from 11.6+/-0.9 mm Hg to 11.8+/-0.9 mm Hg (P<0.05). Cerebral perfusion pressure rose from baseline 72.2+/-2 mm Hg to 97+/-1 mm Hg (P<0.0001). V(m)MCA was already higher on the affected side during baseline measurements. At maximum MAP levels, V(m)MCA rose by 25.5+/-5.5 cm/s on the affected side and by 8.6+/-1.6 cm/s on the contralateral side.


CONCLUSIONS
In patients with large hemispheric stroke without an acute ICP crisis, induced hypertension enhances cerebral perfusion pressure and augments the V(m)MCA(s), more so on the affected side. The ICP slightly increases; however, this is probably not clinically significant.
Schwarz
Stefan
S
Department of Neurology, University of Heidelberg, Heidelberg, Germany. stefan_schwarz@med.uni-heidelberg.de
Georgiadis
Dimitrios
D
Aschoff
Alfred
A
Schwab
Stefan
S
D001783:Blood Flow Velocity / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects; D019299:Decompression, Surgical; D018450:Disease Progression; D005260:Female; D006801:Humans; D006973:Hypertension / Q000139:chemically induced* / Q000503:physiopathology; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery; D007427:Intracranial Pressure / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008991:Monitoring, Physiologic; D009638:Norepinephrine / Q000008:administration & dosage*; D011446:Prospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography
D009638:Norepinephrine