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Luque Linero P, Fernández Moreno MDC, Castilla-Guerra L. Importance of blood pressure monitoring in the acute phase of stroke. An update. HIPERTENSION Y RIESGO VASCULAR 2024; 41:179-185. [PMID: 38538431 DOI: 10.1016/j.hipert.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 07/31/2024]
Abstract
INTRODUCTION The evaluation of blood pressure (BP) is essential in the acute phase of stroke. Although ambulatory blood pressure monitoring (ABPM) is a validated method for BP control, there are few studies assessing the usefulness of ABPM in the acute phase of stroke. DEVELOPMENT A systematic review was carried out according to the PRISMA criteria in the PubMed/Medline and Scopus databases. Those articles that analysed the use of ABPM in the first days after suffering a stroke from 1992 to 2022 were selected. Those articles focused on the post-acute or sequelae phase of the stroke, with a sample size of less than 20 and those where the primary objective was different from the defined one. A total of 28 articles were included. CONCLUSIONS The use of ABPM in patients with recent stroke demonstrates that the normal circadian profile of BP is altered in more than two-thirds of patients and that this will be fundamentally conditioned by the haemodynamic changes that occur on autoregulation of cerebral blood flow, the type of stroke or the response to treatment. Furthermore, these changes in BP have prognostic implications and are correlated with functional status, stroke recurrence and mortality, among others. However, although they continue to be a growing area of research, new studies are needed to clarify the real role of this technique in patients with acute stroke.
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Affiliation(s)
- P Luque Linero
- Unidad de Riesgo Cardiovascular, Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Spain.
| | - M D C Fernández Moreno
- Servicio de Neurología, Hospital Virgen de Valme, Seville, Spain; Departamento de Medicina, Universidad de Seville, Spain
| | - L Castilla-Guerra
- Unidad de Riesgo Cardiovascular, Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Spain; Departamento de Medicina, Universidad de Seville, Spain
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Liu L, Zhang L. Posterior reversible encephalopathy syndrome coexists with acute cerebral infarction: challenges of blood pressure management. Quant Imaging Med Surg 2020; 10:2356-2365. [PMID: 33269231 DOI: 10.21037/qims-20-392] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Hypertension is the most common cause of posterior reversible encephalopathy syndrome (PRES) and acute cerebral infarction. Due to the lack of randomized controlled clinical trials (RCTs), early antihypertensive methods are diverse, even contradictory. So far, there is no consensus on the method of blood pressure (BP) management when the 2 diseases coexist. Generally, antihypertensive therapy should be initiated quickly in the acute phase of PRES, as most patients have elevated BP. However, various factors must be considered before the administration of early antihypertensive therapy in acute cerebral infarction. The coexistence of PRES and acute cerebral infarction is uncommon clinically, and more complicated subsequent BP management. This article reports a case of PRES coexisting with acute lacunar cerebral infarction, which was caused by hypertension. We have analyzed and summarized the antihypertensive principles in PRES and different phases of acute cerebral ischemic injury. We assert that when PRES and acute cerebral infarction coexist, the antihypertensive treatment should be individualized, and careful consideration should be given to the various influencing factors.
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Affiliation(s)
- Luji Liu
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lihong Zhang
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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Moores M, Yogendrakumar V, Bereznyakova O, Alesefir W, Pettem H, Stotts G, Dowlatshahi D, Shamy M. Normal Systolic Blood Pressure at Presentation With Acute Ischemic Stroke Predicts Cardioembolic Etiology. J Am Heart Assoc 2020; 9:e014399. [PMID: 31902321 PMCID: PMC6988141 DOI: 10.1161/jaha.119.014399] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Early insight into the possible etiology of ischemic stroke allows for early initiation of mechanism‐specific secondary stroke prevention. Initial systolic blood pressure during acute ischemic stroke may relate to stroke etiology. We sought to determine whether normotension at presentation with acute ischemic stroke predicts cardioembolic etiology. Methods and Results All patients presenting with acute ischemic stroke within 12 hours of symptom onset at a comprehensive stroke center from January 2015 to December 2017 were assessed. Normotension was defined as systolic blood pressure ≤130 mm Hg. The primary exposure was blood pressure on arrival at the hospital, and the primary outcome was cardioembolic etiology. Multivariable regression with stepwise selection was used to adjust for relevant covariates. We included 683 patients in our analysis, 303 (44%) of whom were diagnosed with cardioembolic etiology at 6 months. The probability of cardioembolic etiology was inversely associated with systolic blood pressure, and initial systolic blood pressure was significantly associated with cardioembolic etiology (odds ratio: 1.15; 95% CI, 1.05 to 1.26). Normotension was associated with 2.62‐fold increased odds of cardioembolic etiology (95% CI, 1.46 to 4.72). Conclusions Normotension at presentation with acute ischemic stroke strongly predicts cardioembolic etiology. These patients may especially benefit from early and prolonged cardiac investigations.
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Affiliation(s)
- Margaret Moores
- Department of Medicine (Neurology) Ottawa Hospital Research Institute & University of Ottawa Canada
| | - Vignan Yogendrakumar
- Department of Medicine (Neurology) Ottawa Hospital Research Institute & University of Ottawa Canada
| | - Olena Bereznyakova
- Department of Medicine (Neurology) Ottawa Hospital Research Institute & University of Ottawa Canada
| | - Walid Alesefir
- Department of Medicine (Neurology) Ottawa Hospital Research Institute & University of Ottawa Canada
| | | | - Grant Stotts
- Department of Medicine (Neurology) Ottawa Hospital Research Institute & University of Ottawa Canada
| | - Dar Dowlatshahi
- Department of Medicine (Neurology) Ottawa Hospital Research Institute & University of Ottawa Canada
| | - Michel Shamy
- Department of Medicine (Neurology) Ottawa Hospital Research Institute & University of Ottawa Canada
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Penn AM, Croteau NS, Votova K, Sedgwick C, Balshaw RF, Coutts SB, Penn M, Blackwood K, Bibok MB, Saly V, Hegedus J, Yu AYX, Zerna C, Klourfeld E, Lesperance ML. Systolic blood pressure as a predictor of transient ischemic attack/minor stroke in emergency department patients under age 80: a prospective cohort study. BMC Neurol 2019; 19:251. [PMID: 31653207 PMCID: PMC6815025 DOI: 10.1186/s12883-019-1466-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 09/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Elevated blood pressure (BP) at emergency department (ED) presentation and advancing age have been associated with risk of ischemic stroke; however, the relationship between BP, age, and transient ischemic attack/minor stroke (TIA/MS) is not clear. METHODS A multi-site, prospective, observational study of 1084 ED patients screened for suspected TIA/MS (symptom onset < 24 h, NIHSS< 4) between December 2013 and April 2016. Systolic and diastolic BP measurements (SBP, DBP) were taken at ED presentation. Final diagnosis was consensus adjudication by stroke neurologists; patients were diagnosed as either TIA/MS or stroke-mimic (non-cerebrovascular conditions). Conditional inference trees were used to define age cut-points for predicting binary diagnosis (TIA/MS or stroke-mimic). Logistic regression models were used to estimate the effect of BP, age, sex, and the age-BP interaction on predicting TIA/MS diagnosis. RESULTS Over a 28-month period, 768 (71%) patients were diagnosed with TIA/MS: these patients were older (mean 71.6 years) and more likely to be male (58%) than stroke-mimics (61.4 years, 41%; each p < 0.001). TIA/MS patients had higher SBP than stroke-mimics (p < 0.001). DBP did not differ between the two groups (p = 0.191). SBP was predictive of TIA/MS diagnosis in younger patients, after accounting for age and sex; an increase of 10 mmHg systolic increased the odds of TIA/MS 18% (odds ratio [OR] 1.18, 95% CI 1.00-1.39) in patients < 60 years, and 23% (OR 1.23, 95% CI 11.12-1.35) in those 60-79 years, while not affecting the odds of TIA/MS in patients ≥80 years (OR 0.99, 95% CI 0.89-1.07). CONCLUSIONS Raised SBP in patients younger than 80 with suspected TIA/MS may be a useful clinical indicator upon initial presentation to help increase clinicians' suspicion of TIA/MS. TRIAL REGISTRATION ClinicalTrials.gov NCT03050099 (10-Feb-2017) and NCT03070067 (3-Mar-2017). Retrospectively registered.
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Affiliation(s)
- Andrew M Penn
- Stroke Rapid Assessment Unit, Island Health, Victoria, BC, Canada
| | - Nicole S Croteau
- Department of Research and Capacity Building, Island Health, 1952 Bay Street, Victoria, BC, V8R1J8, Canada.,Department of Mathematics and Statistics, University of Victoria, Victoria, BC, Canada
| | - Kristine Votova
- Department of Research and Capacity Building, Island Health, 1952 Bay Street, Victoria, BC, V8R1J8, Canada. .,Division of Medical Sciences, University of Victoria, Victoria, BC, Canada.
| | - Colin Sedgwick
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | - Robert F Balshaw
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada
| | - Shelagh B Coutts
- Departments of Clinical Neurosciences, Radiology, and Community Health Services, Hotchkiss Brain Institute, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
| | - Melanie Penn
- Stroke Rapid Assessment Unit, Island Health, Victoria, BC, Canada
| | - Kaitlin Blackwood
- Department of Research and Capacity Building, Island Health, 1952 Bay Street, Victoria, BC, V8R1J8, Canada
| | - Maximilian B Bibok
- Department of Research and Capacity Building, Island Health, 1952 Bay Street, Victoria, BC, V8R1J8, Canada
| | - Viera Saly
- Stroke Rapid Assessment Unit, Island Health, Victoria, BC, Canada
| | - Janka Hegedus
- Stroke Rapid Assessment Unit, Island Health, Victoria, BC, Canada.,Departments of Clinical Neurosciences, Radiology, and Community Health Services, Hotchkiss Brain Institute, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
| | - Amy Y X Yu
- Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Charlotte Zerna
- Departments of Clinical Neurosciences, Radiology, and Community Health Services, Hotchkiss Brain Institute, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
| | - Evgenia Klourfeld
- Departments of Clinical Neurosciences, Radiology, and Community Health Services, Hotchkiss Brain Institute, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
| | - Mary L Lesperance
- Department of Mathematics and Statistics, University of Victoria, Victoria, BC, Canada
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6
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Eizenberg Y, Koton S, Tanne D, Grossman E. Association of age and admission mean arterial blood pressure in patients with stroke—data from a national stroke registry. Hypertens Res 2016; 39:356-61. [DOI: 10.1038/hr.2015.147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 09/15/2015] [Accepted: 10/06/2015] [Indexed: 12/31/2022]
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Weiss A, Beloosesky Y, Kenett RS, Grossman E. Systolic Blood Pressure During Acute Stroke Is Associated With Functional Status and Long-term Mortality in the Elderly. Stroke 2013; 44:2434-40. [DOI: 10.1161/strokeaha.113.001894] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background and Purpose—
The prognostic value of blood pressure (BP) levels during acute stroke has not been adequately studied. Most studies do not use continuous BP measurements, and patients are followed only for a short period. We designed a study to assess, with 24-hour BP monitoring (24H BPM), the impact of BP levels during the first day of stroke, on the short-term functional status and long-term mortality in elderly patients.
Methods—
We studied 177 patients with acute stroke (89 men), mean age 84±6 years. BP was measured on admission and 24H BPM was recorded within 24 hours of admission. After 7 days, patients were assessed for functional status according to the modified Rankin Scale and were subsequently followed up for mortality ≤5 years (mean, 2.07±1.48).
Results—
After 7 days, functional status improved and modified Rankin Scale decreased from 4.2 to 3.7. Follow-up analysis disclosed that 71 patients (27 men and 44 women) had died. Mortality rate was higher in women (50% versus 30%;
P
<0.01) and in patients with a history of congestive heart failure. Only average systolic BP, recorded by 24H BPM, predicted short-term functional status and long-term mortality. Cox proportional hazards model analysis demonstrated that age, sex, congestive heart failure, and average systolic BP >160 mm Hg, recorded by 24H BPM, were associated with increased mortality.
Conclusions—
High systolic BP recorded by 24H BPM on the first day of stroke was found to be associated with unfavorable short-term functional status and long-term mortality in elderly patients.
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Affiliation(s)
- Avraham Weiss
- From the Geriatric Ward, Rabin Medical Center, Petach Tikvah, Israel (A.W., Y.B.); KPA and Department of Applied Mathematics and Statistics, University of Turin, Turin, Italy (R.S.K.); Department of Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel-Hashomer, Israel (E.G.); and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel (A.W., Y.B., E.G.)
| | - Yichayaou Beloosesky
- From the Geriatric Ward, Rabin Medical Center, Petach Tikvah, Israel (A.W., Y.B.); KPA and Department of Applied Mathematics and Statistics, University of Turin, Turin, Italy (R.S.K.); Department of Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel-Hashomer, Israel (E.G.); and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel (A.W., Y.B., E.G.)
| | - Ron S. Kenett
- From the Geriatric Ward, Rabin Medical Center, Petach Tikvah, Israel (A.W., Y.B.); KPA and Department of Applied Mathematics and Statistics, University of Turin, Turin, Italy (R.S.K.); Department of Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel-Hashomer, Israel (E.G.); and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel (A.W., Y.B., E.G.)
| | - Ehud Grossman
- From the Geriatric Ward, Rabin Medical Center, Petach Tikvah, Israel (A.W., Y.B.); KPA and Department of Applied Mathematics and Statistics, University of Turin, Turin, Italy (R.S.K.); Department of Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel-Hashomer, Israel (E.G.); and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel (A.W., Y.B., E.G.)
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The impact of blood pressure hemodynamics in acute ischemic stroke: a prospective cohort study. Int J Emerg Med 2012; 5:3. [PMID: 22252037 PMCID: PMC3292803 DOI: 10.1186/1865-1380-5-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 01/17/2012] [Indexed: 11/23/2022] Open
Abstract
Objective To assess relationships between blood pressure hemodynamic measures and outcomes after acute ischemic stroke, including stroke severity, disability and death. Methods The study cohort consisted of 189 patients who presented to our emergency department with ischemic stroke of less than 24 hours onset who had hemodynamic parameters recorded and available for review. Blood pressure (BP) was non-invasively measured at 5 minute intervals for the length of the patient's emergency department stay. Systolic BP (sBP) and diastolic BP (dBP) were measured for each patient and a differential (the maximum minus the minimum BP) calculated. Three outcomes were studied: stroke severity, disability at hospital discharge, and death at 90 days. Statistical tests used included Spearman correlations (for stroke severity), Wilcoxon test (for disability) and Cox models (for death). Results Larger differentials of either dBP (p = 0.003) or sBP (p < 0.001) were significantly associated with more severe strokes. A greater dBP (p = 0.019) or sBP (p = 0.036) differential was associated with a significantly worse functional outcome at hospital discharge. Those patients with larger differentials of either dBP (p = 0.008) or sBP (0.007) were also significantly more likely to be dead at 90 days, independently of the basal BP. Conclusion A large differential in either systolic or diastolic blood pressure within 24 hours of symptom onset in acute ischemic stroke appears to be associated with more severe strokes, worse functional outcome and early death
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9
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Weiss A, Beloosesky Y, Majadla R, Grossman E. Blood Pressure Monitoring in the Assessment of Old Patients with Acute Stroke. Int J Stroke 2011; 6:182-6. [DOI: 10.1111/j.1747-4949.2011.00592.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Most patients have elevated blood pressure in the early phase of acute stroke that it often returns to normal within approximately seven-days. Most available data on the pattern of blood pressure in acute stroke are based on manual blood pressure measurements. Aims The aims of the present study were to assess with 24 h blood pressure monitoring the pattern of blood pressure in acute stroke, and the change in blood pressure during the first week of event in very old patients. Methods We studied 99 patients with acute stroke (58 males), mean age 83 ± 6 years (range 70–97). Casual blood pressure and 24 h blood pressure monitoring were recorded within 24 h of admission, and then after six- to seven-days. Results Casual blood pressure before beginning the 24 h blood pressure monitoring was 154 ± 23/80 ± 15 mmHg and the average 24 h blood pressure was 147 ± 20/74 ± 11 mmHg. One-week after stroke, casual blood pressure decreased by 15/7 mmHg, whereas 24 h blood pressure decreased by only 7/2 mmHg ( P<0·01). Blood pressure decreased remarkably only in those with admission elevated systolic blood pressure. The change in 24 h systolic blood pressure after one-week correlated to the 24 h admission systolic blood pressure ( R=0·47; P<0·01). Conclusions Casual blood pressure may overestimate blood pressure in stroke patients. Very old patients with stroke exhibit a mild increase in blood pressure during the acute phase, and blood pressure decreases spontaneously only in those with elevated blood pressure levels. Use of 24 h blood pressure monitoring may be helpful in elderly patients with acute stroke.
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Affiliation(s)
- Avraham Weiss
- Geriatric Ward, Rabin Medical Center, Petach Tikva, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yichayaou Beloosesky
- Geriatric Ward, Rabin Medical Center, Petach Tikva, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Riad Majadla
- Geriatric Ward, Rabin Medical Center, Petach Tikva, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ehud Grossman
- Department of Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel-Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Meurer WJ, Sánchez BN, Smith MA, Lisabeth LD, Majersik JJ, Brown DL, Uchino K, Bonikowski FP, Mendizabal JE, Zahuranec DB, Morgenstern LB. Predicting ischaemic stroke subtype from presenting systolic blood pressure: the BASIC Project. J Intern Med 2009; 265:388-96. [PMID: 19019190 PMCID: PMC2707751 DOI: 10.1111/j.1365-2796.2008.02022.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We hypothesized that low presenting systolic blood pressure (SBP) predicted cardioembolic stroke aetiology. DESIGN Active and passive surveillance were used to identify all ischaemic strokes as part of the Brain Attack Surveillance in Corpus Christi (BASIC) population-based study. Multinomial logistic regression was used to examine the association between stroke subtype and first documented SBP in the medical record. SETTING Nueces County, TX, USA (313,645 residents in 2000). The community is urban with the majority of the population residing in the city of Corpus Christi. The area is served by seven adult acute care hospitals. PATIENTS Three hundred and eight cases with completed ischaemic stroke and determined subtype aetiology between January 2000 and December 2002. RESULTS Lower presenting SBP was associated with stroke subtype (P = 0.001). This association remained significant in the final model adjusted for age and history of coronary artery disease. The odds of cardioembolic versus small vessel occlusion increased by 20% (OR = 1.20, 95% CI: 1.07-1.35) for every 10 mmHg decrease in presenting SBP. Other covariates including race/ethnicity, gender, history of hypertension, and diabetes were neither significant predictors of stroke subtype, nor did they confound the association of SBP and stroke subtype. A 5 year increase in age increased the odds of cardioembolic subtype by 25% (OR = 1.25, 95% CI: 1.07-1.47). CONCLUSIONS Lower initial SBP and older age at ischaemic stroke presentation were associated with cardioembolic stroke. Suspicion of cardioembolic stroke should be increased in those presenting with low SBP.
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Affiliation(s)
- W J Meurer
- Stroke Program, University of Michigan Health System, USA
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Micieli G, Cavallini A. The autonomic nervous system and ischemic stroke: a reciprocal interdependence. Clin Auton Res 2008; 18:308-17. [PMID: 18850312 DOI: 10.1007/s10286-008-0495-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Accepted: 08/05/2008] [Indexed: 11/30/2022]
Abstract
Signs and symptoms of autonomic nervous system (ANS) dysfunction are frequently reported after ischemic or haemorrhagic stroke and in many cases they exhibit peculiar patterns in relationship with the site and the extension of brain lesion. However if an ANS disorder can cause or predispose to a stroke is far from being correctly known. Evidences in favor of a pathogenetic mechanism of an ANS dysfunction are reported for myocardial infarction and such data are likely to be appropriate also for atherothrombotic type of ischemic stroke. On the other hand, it is well known that many risk factors for this pathology are strongly correlated with an altered functioning of ANS so that a reciprocal interdependence between ANS and stroke can be hypothesized. This review points to evidence the possible relationship existing between these two conditions and suggests a quite different diagnostic and therapeutic approach to both on the basis of their pathogenetic mechanisms.
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Affiliation(s)
- Giuseppe Micieli
- Neurology and Stroke Unit, IRCCS Istituto Clinico Humanitas, Via Manzoni, 56, 20089, Rozzano, MI, Italy.
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Wong AA, Read SJ. Early changes in physiological variables after stroke. Ann Indian Acad Neurol 2008; 11:207-20. [PMID: 19893676 PMCID: PMC2771993 DOI: 10.4103/0972-2327.44555] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Revised: 09/23/2008] [Accepted: 09/23/2008] [Indexed: 01/04/2023] Open
Abstract
Several aspects of physiology, notably blood pressure, body temperature, blood glucose, and blood oxygen saturation, may be altered after an ischemic stroke and intracerebral hemorrhage. Generally, blood pressure and temperature rise acutely after a stroke, before returning to normal. Blood glucose and oxygen levels may be abnormal in individuals, but they do not follow a set pattern. Several aspects of these physiological alterations remain unclear, including their principal determinants - whether they genuinely affect prognosis (as opposed to merely representing underlying processes such as inflammation or a stress response), whether these effects are adaptive or maladaptive, whether the effects are specific to certain subgroups (e.g. lacunar stroke) and whether modifying physiology also modifies its prognostic effect. Hypertension and hyperglycemia may be helpful or harmful, depending on the perfusion status after an ischemic stroke; the therapeutic response to their lowering may be correspondingly variable. Hypothermia may provide benefits, in addition to preventing harm through protection from hyperthermia. Hypoxia is harmful, but normobaric hyperoxia is unhelpful or even harmful in normoxic patients. Hyperbaric hyperoxia, however, may be beneficial, though this remains unproven. The above-mentioned uncertainties necessitate generally conservative measures for physiology management, although there are notably specific recommendations for thrombolysis-eligible patients. Stroke unit care is associated with better outcome, possibly through better management of poststroke physiology. Stroke units can also facilitate research to clarify the relationship between physiology and prognosis, and to subsequently clarify management guidelines.
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Affiliation(s)
- Andrew A Wong
- Department of Neurology, Princess Alexandra Hospital, Brisbane, Queensland, Australia. Central Clinical School, School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
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Possible mechanisms and controversies of protective effects of risk factors against stroke severity. J Neurol Sci 2008; 267:188-9. [DOI: 10.1016/j.jns.2007.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Fuentes B, Díez-Tejedor E. General Care in Stroke: Relevance of Glycemia and Blood Pressure Levels. Cerebrovasc Dis 2007; 24 Suppl 1:134-42. [DOI: 10.1159/000107389] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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