title: Transcranial ultrasound analysis of cerebral blood flow during induced hypertension in acute ischemic stroke - a case series.
abstract: BACKGROUND
  Current recommendations of stroke treatment favour a moderately elevated blood pressure in the acute phase, based on the concept of an improved cerebral perfusion. Here, cerebral blood flow was assessed in a case series of patients with acute hemodynamic stroke by means of transcranial colour-coded sonography (TCCS) to study the effects of pharmacologically induced hypertension.
  
  
  RESULTS
  We investigated six patients with acute hemodynamic stroke and blood pressure-dependent clinical fluctuation of neurological symptoms. TCCS was performed during the initiation phase of catecholamine-induced controlled hypertension. A blood pressure-dependent increase of flow velocity in the ipsilesional middle and the posterior cerebral artery was found in all patients (mean increase 0.80% and 0.65% per mmHg, respectively).
  
  
  CONCLUSIONS
  Catecholamine-induced hypertension in severe hemodynamic stroke leads to an ultrasound-detectable rise of cerebral blood flow. This finding gives 'proof-of-principle' evidence, supporting active blood pressure management in this selected group of stroke patients. Outcome-related questions of target blood pressure, treatment duration or applicability to other forms of stroke, however, remain to be studied. In this, transcranial ultrasound may be a valuable tool for patient selection and subsequent bedside monitoring.
authors.affiliation: Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany. stephan.schreiber@charite.de.
authors.forename: Jonathan
authors.initials: J
authors.lastname: List
authors.forename: Jens E
authors.initials: JE
authors.lastname: Röhl
authors.forename: Florian
authors.initials: F
authors.lastname: Doepp
authors.forename: José M
authors.initials: JM
authors.lastname: Valdueza
authors.forename: Stephan J
authors.initials: SJ
authors.lastname: Schreiber