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(Stroke. 2002;33:497.)
© 2002 American Heart Association, Inc.

Original Contributions

Effects of Body Position on Intracranial Pressure and Cerebral Perfusion in Patients With Large Hemispheric Stroke

Stefan Schwarz, MD; Dimitrios Georgiadis, MD; Alfred Aschoff, MD Stefan Schwab, MD

From the Departments of Neurology and Neurosurgery (A.A.), University of Heidelberg, Heidelberg, Germany.

Correspondence to Dr Stefan Schwarz, Department of Neurology, University of Heidelberg, 400 Im Neuenheimer Feld, Heidelberg 69120, Germany. E-mail stefan_schwarz{at}med.uni-heidelberg.de

Background and Purpose— The purpose of this study was to prospectively evaluate the effects of body position in patients with large supratentorial stroke.

Methods— We performed 43 monitoring sessions in 18 patients with acute complete or subtotal middle cerebral artery (MCA) territory stroke. Intracranial pressure (ICP) was monitored with a parenchymal probe. Mean arterial blood pressure, ICP, and MCA peak mean flow velocity (V_mMCA) were continuously recorded. Patients with acute ICP crises were excluded. After baseline values at a 0° supine position were attained, the backrest was elevated in 2 steps of 5 minutes each to 15° and 30° and then returned to 0°.

Results— Baseline mean arterial pressure was 90.0±1.6 mm Hg and fell to 82.7±1.7 mm Hg at 15° and 76.1±1.6 mm Hg at 30° backrest elevation (P<0.0001). ICP decreased from 13.0±0.9 to 12.0±0.9 mm Hg at 15° and 11.4±0.9 mm Hg at 30° backrest elevation (P<0.0001). As a result, cerebral perfusion pressure decreased from a baseline value of 77.0±1.8 to 70.0±1.8 mm Hg at 15° and 64.7±1.7 mm Hg at 30° backrest elevation (P<0.0001). V_mMCA was already higher on the affected side during baseline measurements. V_mMCA decreased from 72.8±11.3 cm/s at 0° to 67.2±9.7 cm/s at 15° and 61.2±8.9 cm/s at 30° on the affected and from 49.9±3.7 cm/s at 0° to 47.7±3.6 cm/s at 15° and 46.2±2.2 cm/s at 30° on the contralateral side (P<0.0001).

Conclusions— In patients with large hemispheric stroke without an acute ICP crisis, cerebral perfusion pressure was maximal in the horizontal position although ICP was usually at its highest point. If adequate cerebral perfusion pressure is considered more desirable than the absolute level of ICP, the horizontal position is optimal for these patients.

Key Words: blood flow velocity • body position • cerebral perfusion pressure • intracranial pressure • middle cerebral artery • stroke

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