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acute_ischemic_stroke

Acute ischemic stroke

Cerebral ischemia due to cerebral vasospasm is a feared complication in patients following aneurysmal subarachnoid hemorrhage (SAH).

Epidemiology

Of the approximately 795 000 strokes in the United States annually, 87% are from ischemia and result in significant morbidity and mortality.

Clinical Features

Early neurological deterioration (END) is a common condition associated with poor outcome after acute ischemic stroke.

Diagnosis

Diffusion weighted magnetic resonance imaging (DWI) is widely appreciated as an indispensable tool in the examination of the central nervous system. It is considered useful not only for the detection of acute ischemic stroke but also for the characterization and differentiation of brain tumors and abscess.

Treatment

Outcome

Early neurological deterioration (END) is a common condition associated with poor outcome after acute ischemic stroke.

The majority of victims must endure life-long disabilities that not only affect their livelihood, but also have an enormous societal economic impact.

Blood pressure (BP) variability is independently and linearly associated with the development of neurologic deterioration in acute stage of ischemic stroke 1).

For Nozoe et al. no significant differences in blood pressure, heart rate, and parasympathetic nerve activity were observed. In patients with acute ischemic stroke, it is likely that the increase in sympathetic nervous activity during mobilization is associated with ND 2).

Case series

Nozoe et al., from the Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Kobe, Department of Rehabilitation, Neurosurgical Hospital, Itami, Japan, compared the heart rate variability (HRV) during early mobilization in patients with or without neurological deterioration (ND). They enrolled 7 acute ischemic patients with ND and 14 without ND and measured their HRV in the rest and mobilization by electrocardiography. There was a significant difference in sympathetic nervous activity during mobilization between the 2 groups. However, no significant differences in blood pressure, heart rate, and parasympathetic nerve activity were observed. In patients with acute ischemic stroke, it is likely that the increase in sympathetic nervous activity during mobilization is associated with ND 3).

1)
Chung JW, Kim N, Kang J, Park SH, Kim WJ, Ko Y, Park JH, Lee JS, Lee J, Yang MH, Jang MS, Oh CW, Kwon OK, Jung C, Kim BJ, Han MK, Gorelick PB, Bae HJ. Blood pressure variability and the development of early neurological deterioration following acute ischemic stroke. J Hypertens. 2015 Jul 31. [Epub ahead of print] PubMed PMID: 26237556.
2) , 3)
Nozoe M, Yamamoto M, Kobayashi M, Kanai M, Kubo H, Shimada S, Mase K. Heart Rate Variability During Early Mobilization in Patients with Acute Ischemic Stroke. Eur Neurol. 2018 Sep 11;80(1-2):50-54. doi: 10.1159/000492794. [Epub ahead of print] PubMed PMID: 30205405.
acute_ischemic_stroke.txt · Last modified: 2018/09/12 11:44 by administrador