The Treatment of Brain Ischemia With Vasopressor Drugs

Abstract

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.

Global Ischemia in Dogs: Cerebrovascular CO 2 Reactivity and Autoregulation

“…Miller et al 17 also have observed the constancy of CBF with increased CPP after focal cold-induced cortical injury which was termed "false" autoregulation, since it is unlikely to be comparable to the process of physiological autoregulation observed in normal brain. In contradiction, Wise et al 10 demonstrated amelioration of neurological deficit by increasing systemic arterial pressure in patients suffering focal ischemic insults. Cantu et al" and Miller and Myers" reported that hypotension PI was a significant factor limiting recovery from global cerebral ischemicanoxic insult.…”

“…1214 Although the efficacy of elevated CPP has been demonstrated in studies on patients with primarily focal ischemic infarct, 10 this has not been clearly demonstrated after global ischemia. The effect of CO 2 alteration on neurological recovery after global ischemia is also unclear, but the data of Hossmann et al 4 suggest that PI cerebrovascular reactivity to CO 2 is markedly attenuated.…”

High Blood Pressure in Acute Stroke and Subsequent Outcome

“…Also, some animal data and limited clinical data support the alternative concept of induced hypertension as a treatment strategy. 44,45 Until the results of ongoing randomized, controlled trials are available, 46 the management of high BP in acute stroke will remain controversial.…”

Hipertensão induzida farmacologicamente em paciente com isquemia em território vértebro-basilar associada com estenose vertebral bilateral

“…Desde a década de 1960, a hipertensão induzida é utilizada no tratamento de isquemia cerebral tardia após hemorragia subaracnóide. Na década de 1970, Wise et al 10,11 publicaram dois estudos não-controlados sobre o benefício da hipertensão induzida em pacientes com obstrução de grandes artérias cerebrais. Hillis et al 12 relataram um caso de afasia que respondeu a hipertensão induzida acompanhada de melhora da perfusão na área de Wernicke confirmada por RM de perfusão.…”