Decrease in cerebral blood flow with blood pressure reductions in patients with chronic stroke.

Mori, Sakan; Sadoshima, Seizo; Fujii, Kenichi; Ibayashi, Setsuro; Iino, Kozo; Fujishima, Masatoshi

doi:10.1161/01.str.24.9.1376

Cited by 15 publications

(9 citation statements)

References 25 publications

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“…These findings may have clinical relevance in terms of BP management in the acute phase of stroke [16, 17, 18, 19]. It is known that acute stroke is associated with increased casual and 24-hour BP levels [37, 38], and that the diurnal BP pattern is lost in large cortical strokes and primary intracerebral haemorrhages [39].…”

Section: Discussionmentioning

confidence: 99%

“…Not only are these raised 24-hour BP levels associated with poor short- and long-term outcome after stroke [40, 41], but increasing beat-to-beat BP variability is most marked following acute cortical infarct [27], and may be associated with a poorer prognosis [40]. There is much controversy about introducing antihypertensive medication early in the acute stroke period, but it would appear that a high BP is detrimental to stroke recovery, increasing oedema and probably rendering the penumbra more ischaemic, whereas lowering BP may optimise blood flow to this fragile region [13, 15, 16, 17, 18, 19]. The identification of an agent with no affect on CBF, which leads to a gradual ‘static’ fall in BP, rather than a ‘dynamic’ drop, and that improves BPV, would be particularly attractive [42].…”

Section: Discussionmentioning

confidence: 99%

“…The concept of the ischaemic penumbra is critical to the interpretation of any of these findings, since salvage of this potentially viable area could improve functional outcome. Continuing uncertainty regarding CA in acute ischaemic stroke means that there is still no consensus on the management of blood pressure (BP) in the acute stroke period, since both induced hypertension and hypotension could be argued to be either beneficial or harmful to the penumbra [13, 15, 16, 17, 18, 19]. …”

Section: Introductionmentioning

confidence: 99%

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Dynamic But Not Static Cerebral Autoregulation Is Impaired in Acute Ischaemic Stroke

Dawson

Blake²,

Panerai³

et al. 2000

Cerebrovasc Dis

184

181

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It remains unclear as to whether dynamic and static cerebral autoregulation (CA) are impaired in acute ischaemic stroke, and whether these changes are related to stroke subtype. This could have important implications with regard to post-stroke prognosis and the management of blood pressure (BP) in the acute post-ictal period. Using transcranial Doppler ultrasonography and non-invasive manipulation of BP, we compared both mechanisms in 61 patients with ischaemic stroke within 96 h of ictus, and 54 age- and sex-matched controls. There was no difference in static and dynamic CA indices between the various stroke subtypes. Combining all stroke subtypes dynamic autoregulation, as measured using thigh cuff release, was significantly impaired in both the affected and non-affected stroke hemispheres compared to controls (mean autoregulation index 4.1 ± 3.3, 4.8 ± 3.1 and 6.2 ± 2.3, respectively, p < 0.05). By comparison static autoregulation, assessed using isometric hand grip and thigh cuff inflation, was not significantly different. In conclusion, dynamic but not static CA appears to be globally impaired in acute ischaemic stroke. This deserves further study and may identify possibilities for therapeutic intervention.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Dynamic But Not Static Cerebral Autoregulation Is Impaired in Acute Ischaemic Stroke

Dawson

Blake²,

Panerai³

et al. 2000

Cerebrovasc Dis

184

181

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“…In our study, brain edema was considered to have resolved within the first 4 weeks according to the findings of follow-up CT scans; thus, there were minimal (if any) effects of edema on the results. 20 Assessments of brain functions were likewise completed after maximum recovery from stroke. The first assessment of HDS made at the beginning of rehabilitation was not used because it is not always the best score for each patient, and recovery had already occurred in some cases.…”

Section: Discussionmentioning

confidence: 99%

“…- 20 The 133 Xe gas mixture with air (3 mCi/L) was administered by means of a close-fitting face mask for 1 minute, and…”

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confidence: 99%

Relation of cerebral blood flow to motor and cognitive functions in chronic stroke patients.

Mori

Sadoshima

Ibayashi

et al. 1994

Stroke

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The aim of this study was to examine the levels of cerebral blood flow in relation to motor and cognitive functions in 300 chronic unilateral stroke patients (age, 64 +/- 12 years; mean +/- SD). Cerebral blood flow was measured by the 133Xe inhalation method, adjusted for age, sex, and PCO2 level. Motor function was scored according to Brunnstrom hemiplegic staging and cognitive function according to the Hasegawa dementia rating scale tested in Japanese. Asymmetries of blood flow between affected and nonaffected hemispheres increased with lesion size and were highest in 11 embolic strokes (20 +/- 9%) and higher in 80 nonembolic cortical infarctions (11 +/- 11%) and 76 hemorrhages (9 +/- 7%) than in the group of 133 subcortical infarctions (2 +/- 6%) or 16 control subjects (1 +/- 2%). Severity of hemiparesis correlated with decreased cerebral blood flow in the affected hemisphere (P < .01) and increased hemispheric asymmetries of blood flow (P < 001). Cognitive impairments, after adjusting for age, correlated with decreased cerebral blood flow in the nonaffected hemisphere (P < .0001), left hemispheric lesions (P < .0005), and embolic stroke (P < .005) but not with asymmetries of blood flow. Among 67 patients having bilateral reductions of cerebral blood flow, 25 patients with left hemispheric lesions showed more severe cognitive impairments than among 42 patients with right hemispheric lesions (P < .05). We confirmed that severity of hemiparesis correlated with the degree of asymmetries of cerebral blood flow, reflecting the extent and location of the lesions. Bilateral reductions of cerebral blood flow in patients with left hemispheric lesions may in part contribute to cognitive impairments, indicating reductions of global neuronal activities in the contralateral hemisphere or diffuse cerebrovascular changes. Further studies of cerebral metabolism and follow-up of cerebral circulation are required to reveal the pathophysiology and clinical consequences.

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Hypertension Treatment

Flack¹,

Patel²,

Mehra³

et al. 2004

Transient Ischemic Attacks

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Decrease in cerebral blood flow with blood pressure reductions in patients with chronic stroke.

Cited by 15 publications

References 25 publications

Dynamic But Not Static Cerebral Autoregulation Is Impaired in Acute Ischaemic Stroke

Dynamic But Not Static Cerebral Autoregulation Is Impaired in Acute Ischaemic Stroke

Relation of cerebral blood flow to motor and cognitive functions in chronic stroke patients.

Hypertension Treatment

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