J Clin Neurol.  2007 Dec;3(4):187-191. 10.3988/jcn.2007.3.4.187.

Induced Hypertensive Therapy in an Acute Ischemic Stroke Patient with Early Neurological Deterioration

• Kim HJ
• Kang DW

• KMID: 1808552
• DOI: http://doi.org/10.3988/jcn.2007.3.4.187

Abstract

Poststroke hypotension may be related to early neurological deterioration and infarct progression by decrease of cerebral perfusion, particularly in patients with ischemic penumbra. However, optimal management guideline of blood pressure in the setting of acute stroke is absent, and remains a matter of debate. We report here a patient who had early neurological deterioration accompanied by systemic hypotension. Phenylephrine-induced hypertensive therapy by imaging-based decision making successfully restored neurologic dysfunction in this patient.

Keyword

Acute ischemic stroke; Early neurological deterioration; Induced hypertensive therapy

MeSH Terms

Blood Pressure
Decision Making
Humans
Hypotension
Neurologic Manifestations
Perfusion
Stroke*

Figure

• 

  Figure 1 A 68-year-old man presented with mild aphasia, dysarthria and right arm weakness (NIHSS score = 4). Initial MRI shows acute ischemic lesions in the left middle cerebral artery (MCA) territory on diffusion weighted image (DWI) (A) with a larger perfusion defect on mean transit time map (B) not accompanied with clot or hemorrhage on gradient echo image (GRE) (C) and severe stenosis or occlusion of left proximal MCA on MR angiography (D). At hospital day 4, global aphasia, left gaze preference, right facial palsy, and right hemiparesis grade IV developed (NIHSS score = 12). DWI shows some additional scattered ischemic lesions in the left MCA territory (E). Intra-arterial thrombolysis was performed, and urokinase of 100,000 unit was applied. Final angiogram shows that left MCA is still occluded (F).

• 

  Figure 2 Temporal relationship between blood pressure and neurological dysfunction.

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