Published online before print July 14, 2005, doi: 10.1161/01.STR.0000173183.36331.ee
(Stroke. 2005;36:1684.)
© 2005 American Heart Association, Inc.
Original Contributions |
Dynamic Cerebral Autoregulation in Acute Ischemic Stroke Assessed From Spontaneous Blood Pressure Fluctuations
From the Department of Neurology and Clinical Neurophysiology (M.Reinhard, B.G., A.Harloff, A.Hetzel), University of Freiburg, Germany; Center for Data Analysis and Modeling (M.Roth, J.T.), University of Freiburg, Germany; Academic Neurosurgery Unit (M.C.), Addenbrooke’s Hospital, University of Cambridge, UK.
Correspondence to Matthias Reinhard, MD, Department of Neurology and Clinical Neurophysiology, University of Freiburg, Neurocenter, Breisacherstr 64, D-79106 Freiburg, Germany. E-mail REINHARD{at}nz.ukl.uni-freiburg.de
Background and Purpose— This study investigates dynamic cerebral autoregulation assessed from spontaneous blood pressure (ABP) and cerebral blood flow velocity (CBFV) fluctuations and its time course in acute ischemic stroke.
Methods— Forty patients admitted with acute ischemic stroke in the territory of the middle cerebral artery (MCA) were enrolled. Admission National Institutes of Health Stroke score was 6±4. Study 1 was performed within 22 (±11) hours and study 2 was performed within 134 (±25) hours of ictus. The final analysis comprised 33 and 29 patients for study 1 and study 2, respectively. Twenty-five age- and sex-matched controls were studied. ABP (Finapres method) and CBFV in both MCAs (transcranial Doppler) were recorded over 10 minutes. Correlations between diastolic and mean ABP and CBFV fluctuations were averaged, yielding the correlation coefficient indices (Dx, Mx). Transfer function analysis was applied to obtain phase shift and gain between ABP and CBFV oscillations.
Results— No disturbance of autoregulation was indicated by all parameters at study 1. Separate analyses for clinical severity, stroke side, and size did not reveal significant differences for the various autoregulatory indices at study 1 and 2. At study 2, MCA flow velocity was significantly increased on both sides, the autoregulation index Mx was slightly but significantly (P<0.05) worse on both sides in comparison to study 1, and phase showed a trend toward poorer values on affected sides. No significant differences to controls occurred. Clinical outcome in patients completing both studies was good in all but one patient.
Conclusions— Dynamic cerebral autoregulation assessed from spontaneous blood pressure fluctuations does not seem to be relevantly disturbed in early minor MCA stroke. At the subacute stage, slight autoregulatory disturbance may be present.
Key Words: cerebral ischemia • stroke • ultrasonography, Doppler, transcranial
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