Induced-hypertension in progressing lacunar infarction

Lim, Tae Sung; Hong, Ji Man; Lee, Jin Soo; Shin, Dong Hoon; Choi, Jun Young; Huh, Kyu Ha

doi:10.1016/j.jns.2011.06.009

Cited by 30 publications

(20 citation statements)

References 33 publications

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“…Treatments to improve local perfusion, such as induced hypertensive therapy, are an important patient management strategy. One retrospective study found that phenylephrine-induced hypertension can result in early motor restoration without serious side effects in progressing SSI ( 36 ). A multicenter randomized clinical trial showed that phenylephrine-induced hypertension was safe and resulted in early neurologic improvement and long-term functional independence in patients with non-cardioembolic stroke.…”

Section: Discussionmentioning

confidence: 99%

The Length of an Infarcted Lesion Along the Perforating Artery Predicts Neurological Deterioration in Single Subcortical Infarction Without Any Relevant Artery Stenosis

et al. 2020

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Objectives: This study aimed to assess image biomarkers of early neurological deterioration in single subcortical infarction (SSI) without any relevant artery stenosis. Methods: Between June 2005 and December 2009, consecutive patients with SSI within 24 h of symptom onset were enrolled. Magnetic resonance angiography of the brain and neck was obtained from all patients to confirm the absence of any stenosis of relevant arteries. We defined early neurological deterioration (END) as neurological worsening by ≥ 2 points based on the initial National Institutes of Health Stroke Scale score during the first week post admission or prior to hospital discharge. A multiple logistic regression analysis was used to evaluate the independent predictors of END in SSI. Results: A total of 205 patients (109 males; aged 63.9 ± 11.0 years, range 39–90 years) were enrolled, of whom 158 (77%) remained stable or improved, while 47 (23%) showed neurological worsening. There were significant differences in the maximum diameter of the largest area on an axial view and in the number of slices showing cerebral infarction on a transverse plane between patients with and without END. A adjusting for age, hypercholesterolemia, hemoglobin, NIHSS on admission and these magnetic resonance imaging characteristics, the occurrence of having three or more slices showing the cerebral infarction on a transverse plane was an independent predictor of END in SSI without relevant artery stenosis (1 vs. 3; OR 14.281; 95% CI 1.76–115.8; p = 0.013, 1 vs. 4; OR 14.04; 95% CI 1.65–119.57; p = 0.016). Conclusion: The longitudinal length of the infarcted lesion along the perforating artery predicts END in cases of acute SSI without any relevant artery stenosis.

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Section: Discussionmentioning

confidence: 99%

The Length of an Infarcted Lesion Along the Perforating Artery Predicts Neurological Deterioration in Single Subcortical Infarction Without Any Relevant Artery Stenosis

et al. 2020

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“…The mechanisms by which subcortical SVD may lead to CMBs in both lobar and deep brain regions remain to be elucidated. The deep perforating artery territory, where most deep CMBs are located, is vulnerable to the effects of high blood pressure because of the lack of resistant arterioles . Conversely, the superficial perforating arteries of pial origin that may be responsible for lobar CMBs may also lose autoregulatory function in the presence of chronic hypertension, exposing them to excessive pressure, resulting in damage to the smooth muscle cells and microbleeding .…”

Section: Discussionmentioning

confidence: 99%

Pathogenesis of cerebral microbleeds: In vivo imaging of amyloid and subcortical ischemic small vessel disease in 226 individuals with cognitive impairment

Park

Seo

Kim

et al. 2013

Annals of Neurology

146

105

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“…A few studies have experimented induced hypertension as adjuvant therapy to sustain blood flow in the ischemic area (92,93). Recently Lim et al (94) have investigated the effect of induced hypertension in 82 LS patients showing motor progression within seven days after symptoms onset. Fiftytwo patients with systolic BP at motor progression of 140·6 Ϯ 18·4 mmHg (mean Ϯ standard deviation) received phenylephrine, and 30 patients with systolic BP value of 160·2 Ϯ 24·2 mmHg received conventional treatment (anticoagulation).…”

Section: Induced Hypertensionmentioning

confidence: 99%

Progressive Lacunar Stroke: Review of Mechanisms, Prognostic Features, and Putative Treatments

Bene

Palumbo²,

Lamassa³

et al. 2012

International Journal of Stroke

119

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Lacunar stroke is generally considered to have a fair outcome. However 20-30% of patients with lacunar stroke worsen neurologically in hours or days after onset, reaching eventually an unexpectedly severe disability status. In the field of acute stroke, progressive lacunar stroke remains an important unresolved practice problem, because as yet no treatment does exist proven to prevent or halt progression. Pathophysiology of progression is yet incompletely understood. Hemodynamic factors, extension of thrombosis, excitotoxicity, and inflammation, have been proposed as possible mechanisms of progression. A few clinical studies also aimed at establishing presentation features that may help identifying patients at risk of deterioration. In this paper, we review hypothesized mechanisms of lacunar stroke progression and possible markers of early deterioration. Moreover, based on putative mechanisms and suggestions from reported evidence, we propose a few treatments that seem worthy to be tested by randomized clinical trials.

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Induced-hypertension in progressing lacunar infarction

Cited by 30 publications

References 33 publications

The Length of an Infarcted Lesion Along the Perforating Artery Predicts Neurological Deterioration in Single Subcortical Infarction Without Any Relevant Artery Stenosis

The Length of an Infarcted Lesion Along the Perforating Artery Predicts Neurological Deterioration in Single Subcortical Infarction Without Any Relevant Artery Stenosis

Pathogenesis of cerebral microbleeds: In vivo imaging of amyloid and subcortical ischemic small vessel disease in 226 individuals with cognitive impairment

Progressive Lacunar Stroke: Review of Mechanisms, Prognostic Features, and Putative Treatments

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