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(Stroke. 2002;33:998.)
© 2002 American Heart Association, Inc.

Original Contributions

Effects of Induced Hypertension on Intracranial Pressure and Flow Velocities of the Middle Cerebral Arteries in Patients With Large Hemispheric Stroke

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

From the Department of Neurology (S. Schwarz, D.G., S. Schwab) 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— Our aim was to prospectively evaluate the effects of induced arterial hypertension in patients with large ischemic stroke.

Methods— A total of 47 monitoring sessions in 19 patients with acute, complete, or subtotal middle cerebral artery (MCA) territory stroke were performed. Intracranial pressure (ICP) was monitored using a parenchymal catheter. Mean arterial blood pressure (MAP), ICP, and peak mean flow velocity of the middle cerebral arteries (V_mMCA) were continuously recorded. Patients with acute ICP crises were excluded. After obtaining baseline values, MAP was raised by an infusion of norepinephrine to reach an MAP increase of at least 10 mm Hg. After MAP had reached a peak plateau level, the norepinephrine infusion was stopped.

Results— Baseline MAP was 83.6±1.6 mm Hg and rose to 108.9±2.0 mm Hg after infusion of norepinephrine. ICP slightly increased from 11.6±0.9 mm Hg to 11.8±0.9 mm Hg (P<0.05). Cerebral perfusion pressure rose from baseline 72.2±2 mm Hg to 97±1 mm Hg (P<0.0001). V_mMCA was already higher on the affected side during baseline measurements. At maximum MAP levels, V_mMCA rose by 25.5±5.5 cm/s on the affected side and by 8.6±1.6cm/s on the contralateral side.

Conclusions— In patients with large hemispheric stroke without an acute ICP crisis, induced hypertension enhances cerebral perfusion pressure and augments the V_mMCA(s), more so on the affected side. The ICP slightly increases; however, this is probably not clinically significant.

Key Words: blood flow velocity • cerebral perfusion pressure • hypertension • intracranial pressure • norepinephrine • stroke

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