Hypertension is one of the risk factors for stroke. In the United States, stroke is the third leading cause of death, with a death rate of 146,664 people. Pulsatility index (PI) examination on transcranial Doppler is a value generated by blood flow velocity and blood viscosity. Methods: Retrospective analytic observational study with a cross-sectional study design in patients with acute thrombotic stroke with hypertension according to JNC VIII criteria. Data were obtained from secondary data from medical records of patients treated in the nervous room of Dr RSUD. Soetomo, in the period from February 2019 to February 2022, met the inclusion criteria, namely being over 18 years old, undergoing a TCD examination and having a stroke for the first time. Statistical analysis using Spearman correlation test with a significance value <0.05. Results: A total of 46 subjects met the inclusion and exclusion criteria. Tension with a mean of 152.00 ± 20.87 and a mean value of PI 1.08 ± 0.73. The Spearman statistical test showed a positive correlation with a substantial and statistically significant relationship level (rho = 0.712, p=0.002). Conclusion: there is a strong significant relationship between hypertension and the pulsatility index in patients with acute thrombotic stroke

A cerebral abscess can happen due to a nearby brain infection, other rare body parts spread, head injury and surgery procedures. Intracranial Klebsiella pneumoniae infection rarely happens and usually occurs in immunocompromised patients. We reported a case of a 50 years old immunocompetent woman with prior tumor excision that progressed to a cerebral abscess. The patient came to the ER unconscious with progressive right-side weakness, pus from previous operation scar, fever and headache since few days’ pre-admission. Laboratory findings were leukocyte 13.710, neutrophil 9%, CRP 7.6, and negative HIV test. The contrast CT scan resulted in a multiloculated ring enhancement left frontal lobe lesion sized 5.8x6.9x5.0 cm and perifocal oedema. Open craniotomy managed to evacuate ±40cc. The microbiology culture tested positive for Klebsiella pneumoniae. Despite proper technique and administration of prophylaxis antibiotics, severe infection that requires immediate intervention still develops in a small group of patients. Klebsiella pneumoniae is a common pathogen causing cerebral abscess in both immunocompromised and healthy patients. Pus drainage and immediate antibiotics administration improved all symptoms, including hemiparesis. This case highlights the importance of quick and right therapy.

Hemodynamic stroke is caused by hypoperfusion, instead of infarction or embolism, with a prevalence of approximately 10% of all cerebral infarctions. Introducing hypoperfusion as the causative factor for ischemic stroke is crucial in patient care and management. It can be demonstrated through clinical symptoms, physical examination, and diagnostic imaging. Transcranial Doppler (TCD) and Digital Subtraction Angiography (DSA) examinations to determine cerebral blood flow are very helpful in assessing cerebral perfusion improvement in hemodynamic stroke. A 49-year-old male patient complained of sudden weakness in the right half of the body after waking up, accompanied by a headache and communication difficulties. He also experienced weakness of the right upper and lower limb 1 week before hospital admission and improved 10 hours afterward. The results of the physical examination indicated differences in right and left arm systolic blood pressure of more than 20 mmHg, severe dysarthria, central right facial and lingual palsy, right hemiparesis, and right hemihypesthesia. The results of the CT scan of the head without contrast revealed a subacute cerebral ischemia infarct in the cortical/subcortical left parietal lobe.