Noninvasive monitoring of hypertensive breakthrough of cerebral autoregulation in a patient with acute ischemic stroke.
OBJECTIVE
We describe the first documentation of hypertensive breakthrough of cerebral autoregulation in a patient with acute stroke with transcranial Doppler sonography.


METHODS
A 55-year-old patient with acute left hemispheric stroke was treated with moderate hypothermia. He died of transtentorial herniation 4 days after admission. Static cerebral autoregulation (sCA) of the unaffected hemisphere was evaluated 6 times during this period and always found to be intact. A bolus application of epinephrine resulted in a hypertensive episode (mean arterial pressure (MAP) 135 mm Hg); hypertensive breakthrough of cerebral autoregulation was evident when MAP exceeded approximately 110 mm Hg. Interestingly, no such breakthrough was evident during testing of sCA, even when MAP reached 120 mm Hg.


CONCLUSIONS
Our observation suggests that (1) the pace of the MAP increase is crucial for the occurrence of a hypertensive breakthrough of the cerebral autoregulation and (2) the disturbance of cerebral autoregulation is potentially longer as previously assumed.
Georgiadis
D
D
Department of Neurology, University of Heidelberg, Germany. Dimitrios.Georgiadis@nos.usz.ch
Schwarz
S
S
Cencetti
S
S
Schwab
S
S
D018660:Blood Pressure Monitoring, Ambulatory; D002545:Brain Ischemia / Q000175:diagnosis / Q000503:physiopathology*; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000502:physiology*; D003951:Diagnostic Errors; D006706:Homeostasis / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000175:diagnosis / Q000503:physiopathology*; D017585:Ultrasonography, Doppler, Transcranial