Effect of dehydration on the development of collaterals in acute middle cerebral artery occlusion

Abstract

Hydration status is associated with the development of collateral flow after acute MCA occlusion. This preliminary study provides an imaging clue that hydration status and early hydration therapy could be important for acute stroke management.

The influence of dehydration on the prognosis of acute ischemic stroke for patients treated with tissue plasminogen activator

“…Previous studies from our institution have demonstrated that collateral blood flow around the middle cerebral artery does not develop as robustly in dehydrated patients as it does in well-hydrated patients, when assessed with magnetic resonance imaging at 3 days post stroke [20]. We have also generated substantial data that show an increased risk of stroke in evolution within a 3-day window when dehydration was assessed by either the BUN/Cr ratio or by urine specific gravity [21, 23–25].…”

“…Other studies did report data for age and gender, and the results are mixed. Among two of our own studies [20, 22], only one found that dehydration was associated with age and female gender [22]. The study that did not find over-representation of older patients and women in the dehydrated group, by Chang et al, was a more specialized study that only enrolled patients who received MRI within 3 days of admission and were diagnosed with an occlusion of the middle cerebral artery [20].…”

“…The eligible patients were divided into 2 groups based on hydration status, as assessed by the BUN/Cr ratio. This ratio has been used as an indicator of dehydration in previous studies by our group and by others [17, 18, 20–26, 35–37]. Dehydrated patients had a BUN/Cr ratio ≥ 15 and those patients with a BUN/Cr ratio < 15 were placed in the non-dehydrated group.…”

“…More recently, Rowat et al and Schrock et al assessed mortality and discharge status [17, 18]. At our stroke referral center in Taiwan, a registry established in 2006 (Stroke Registry of the Chang Gung Healthcare System [SRICHS] [19]) has allowed a comprehensive assessment of the negative impact of dehydration on numerous features of IS progression and recovery, including neurological deterioration, development of collaterals, infection rate, and performance on disability scales [20–26]. Collectively, the data suggest that hydration therapy should be a central feature of stroke management, and recent guidelines acknowledge this [27].…”

Dehydration is a strong predictor of long‐term prognosis of thrombolysed patients with acute ischemic stroke

“…USG > 1.030 has also been reported as a marker in only one study with subjects in an ultralow‐humidity environment (Su et al., 2006). Dehydration is common among stroke subjects and is associated with poor outcome (Chang et al., 2016). Hypoperfusion, renal impairment, and hypercoagulability associated with dehydration status may contribute to the development of ischemic stroke (Bhalla et al., 2000; Jauch et al., 2013; Kelly et al., 2004).…”