title: Induced hypertension for the treatment of acute MCA occlusion beyond the thrombolysis window: case report.
abstract: BACKGROUND
  A minority of stroke patients is eligible for thrombolytic therapy. Small pilot case series have hinted that elevation of incident arterial blood pressure might be associated with a favorable prognosis either in acute or subacute stroke. However, these patients were not considered for thrombolytic therapy and were not followed - up systematically. We used pharmacologically induced hypertension in a stroke patient with middle cerebral artery (MCA) occlusion ineligible for thrombolysis that was followed-up by radiological, clinical and functional outcome assessment.
  
  
  METHODS
  A patient with acute embolic MCA occlusion producing a large, ischemic penumbra confirmed by perfusion CT was treated by induced hypertension with phenylephrine started within 4 h of admission. Increase in the mean arterial pressure by 20% led to a reduction of neurological deficit by 3 points on the National Institute of Stroke Scale. MRI and CT scans performed during phenylephrine infusion showed the presence of limited subcortical and cortical infarct changes that were clearly less extensive than the perfusion deficit in the brain perfusion CT at baseline, found in the absence of MCA patency. No complications due to induced hypertension therapy occurred. Moderate functional improvement up to modified Rankin scale 2 at follow up took place.
  
  
  CONCLUSIONS
  Induced hypertension in acute ischemic stroke seems clinically feasible and may be beneficial in selected normo- or hypotensive stroke patients not eligible for thrombolytic recanalization therapy.
authors.affiliation: Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland. tanya.bogoslovsky@hus.fi <tanya.bogoslovsky@hus.fi>
authors.forename: Tanya
authors.initials: T
authors.lastname: Bogoslovsky
authors.forename: Olli
authors.initials: O
authors.lastname: Häppölä
authors.forename: Oili
authors.initials: O
authors.lastname: Salonen
authors.forename: Perttu J
authors.initials: PJ
authors.lastname: Lindsberg
mesh_terms: D000208:Acute Disease; D000368:Aged; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D010656:Phenylephrine / Q000008:administration & dosage*; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
chemical_list: D014662:Vasoconstrictor Agents; D010656:Phenylephrine