Focal cerebral hyperemia in acute stroke. Incidence, pathophysiology and clinical significance.

Abstract

SUMMARY In a consecutive study comprising 41 patients with completed stroke of less than 72 hours duration, cerebral angiograpby and measurements of the regional cerebral blood flow (rCBF) were performed within 24 hours after admission. The rCBF study was done using the 133-Xenon intracarotid injection method and a 254 multi-detector camera. CT scan was done 24 hours after the rCBF study.Focal cerebral hyperemia was found in 16 patients. The study revealed 3 different types of hyperemia: Border-zone hyperemia, surrounding iscbemic areas, was seen in patients with occluded arteries on angiograpby, presumably resulting from accumulation of acid metabolites in the border-zone of acute infarcts. Postischemic hyperemia was seen in patients without occlusion, presumably due to recanalization of a prior occluded artery. Remote hyperemia was found distant from the infarcted area, presumably due to local tissue pressure on brain tissue.Cortical infarcts (10 patients) all had extensive hypereraic areas. Because the 254 detector camera has an excellent resolution in the cortical surface, our findings strongly suggest that all acute cerebral infarcts are, in fact, associated with hyperemic areas. The hyperemic areas are often extensive and vascular reactivity is commonly impaired. It is suggested that treatment aimed at reducing blood flow in hyperemic areas might improve prognosis.Stroke, Vol 12, No 5, 1981ISCHEMIC LESIONS are responsible for the neurological deficits in most patients with stroke.

19F Imaging of Cerebral Blood Oxygenation in Experimental Middle Cerebral Artery Occlusion: Preliminary Results

“…Although only relatively hyperaemic, this cortical strip may D. EIDELBERG ET AL. be designated as a region of border zone hyper aemia (Olsen et al, 1981). Our demonstration of relative hypoxaemia in this border zone by P02 mapping confirms the invasive measurements of Sutherland et al (1984) in perfluorocarbon ex changed cats.…”

“…Unlike the signal as ymmetry in the retia, the collaterals opened during occlusion per sist following clip release, perhaps owing to the presence of an endogenous vasodilator such as aci dosis (Lassen, 1966;Yamaguchi et a!., 1971). These persistent channels are likely to constitute the basis for the postischaemic hyperaemia encountered in experimental and clinical stroke (Sundt and Waltz, 1971;Olsen et a!., 1981;Hakim et a!., 1987).…”

Hemodynamic Consequences of Common Carotid Artery Thrombosis and Thrombogenically Activated Blood in Rats

“…, 1988a), spon taneous recanalization of embolized microvessels may be occurring in our study. Hyperemia remote from an infarcted area, including the contralateral hemisphere, has also been described (Cronqvist and Laroche, 1967;Heiss et aI., 1976;Hji)edt Rasmussen et al , 1967;Olsen et al, 1981;Dietrich et aI., 1986). In our study, CCA T or the infusion of TAB with subsequent vasoconstriction of the distal extra-and intracranial vasculature may have led to a temporary increase of blood flow to the contralat eral hemisphere via the communicating arteries of the circle of Willis.…”

“…Hyperemia or "lux ury perfusion" has been observed under various experimental and clinical conditions (Lassen, 1966;Cronqvist and Laroche, 1967;H\2ledt-Rasmussen et aI., 1967;Sundt and Waltz, 197 1;Schuier et aI., 1978;Olsen et aI., 198 1;Kagstrom et al, 1983a,b;Dietrich et al, 1986Dietrich et al, , 1987. Three different types of hyperemia have been described, including border zone, postischemic, and remote hyperemia (Olsen et al, 1981). In the present study, ischemic foci may have released vasodilative substances into sur rounding brain regions causing border zone hyper emia.…”

Effect of Preischemia Cyclooxygenase Inhibition by Zomepirac Sodium on Reflow, Cerebral Autoregulation, and EEG Recovery in the Cat after Global Ischemia

“…1971;Rehncrona et aI. , 1979;Olsen and Larsen, 1981;Hossmann, 1982;Siesjo, 1984). During and following the period of cerebral ischemia, there are several indexes indi cating a clear derangement of cerebral and cerebro vascular function.…”