Vasopressor drugs were administered to 13 patients soon after the development of focal brain ischemia even though there was no significant decrease in their blood pressure. The neurological function of five patients improved following an increase of their blood pressure to levels of 150 to 170/85 to 100 mm Hg. Focal brain dysfunction recurred whenever the blood pressure was allowed to fall to the initial level during the immediate postinsult period. Significant recovery was maintained in three of these five patients; neurological function in these three did not deteriorate when the blood pressure was allowed to fall to levels of 90/60, 100/70 and 120/80, respectively, after the immediate postischemic period. The critical blood pressure level required for improvement of brain function during the ischemic episode was not lowered by simultaneous treatment with low-molecular-weight dextran, hyperosmotic agents, dexamethasone and aminophylline in case 1 or by treatment with papaverine in case 3.

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In 122 patients with unilateral brain or ocular ischemia, supraorbital Doppler studies revealed evidence of obstruction in 44 of 51 common or internal carotid arteries having greater than 70 percent stenosis, and in only 4 of 23 arteries with 50 to 70 percent stenosis. Ipsilateral bruits were present in 52 of 74 carotid arteries with greater than 50 percent stenosis, and in 19 of 37 arteries with less than 50 percent stenosis. Only one false-positive Doppler result occurred, and only 15 false-positive midcervical bruits were present in 129 normal carotid arteries. Unfortunately, these studies do not decrease the need for radiopaque arteriography, since in 11 of 53 patients, a potentially operable, symptomatic, nonobstructive common or internal carotid artery lesion would not have been suspected by supraorbital Doppler testing and auscultation alone.

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