Journal article
Association between neurologic improvement with decline in blood pressure and recanalization in stroke
JAMA neurology, Vol.71(12), pp.1555-1558
12/2014
DOI: 10.1001/jamaneurol.2014.2036
PMCID: PMC5257035
PMID: 25330362
Abstract
Patients with stroke often have a decline in blood pressure after thrombolysis. Neurologic improvement could result from recanalization or better collateral flow despite persistent occlusion. We hypothesized that neurologic improvement with concurrent decline in blood pressure may be a clinical sign of recanalization after intravenous tissue plasminogen activator.
Patients treated with intravenous tissue plasminogen activator at Suburban Hospital, Bethesda, Maryland, and MedStar Washington Hospital Center, Washington, DC, from 1999 to 2009 were included in the study if they had pretreatment and 24-hour magnetic resonance angiographic scans, National Institutes of Health Stroke Scale scores at those times, and proximal middle cerebral artery occlusion demonstrated prior to treatment. The recanalization status on 24-hour magnetic resonance angiography was classified as none, partial, or complete. Seventeen patients met study criteria. On 24-hour magnetic resonance angiography, 3 patients had no recanalization, 8 had partial recanalization, and 6 had complete recanalization. At 24 hours after thrombolysis, neurologic improvement with concurrent decline in systolic blood pressure of 20 mm Hg or greater was seen in 4 patients with partial recanalization, 4 patients with complete recanalization, and none of the patients with no recanalization.
Neurologic improvement with concurrent decline in systolic blood pressure of 20 mm Hg or greater after intravenous tissue plasminogen activator may be a clinical sign of recanalization. This observation needs confirmation in a larger cohort.
Details
- Title: Subtitle
- Association between neurologic improvement with decline in blood pressure and recanalization in stroke
- Creators
- Nandakumar Nagaraja - Stroke Diagnostics and Therapeutics Section, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland2University of Iowa, Iowa CitySteven Warach - University of Texas Southwestern Medical Center, AustinAmie W Hsia - Stroke Diagnostics and Therapeutics Section, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland4MedStar Washington Hospital Center, Washington, DCHarold P Adams Jr - University of Iowa, Iowa CitySungyoung Auh - National Institute of Neurological Disorders and Stroke, Bethesda, MarylandLawrence L Latour - Stroke Diagnostics and Therapeutics Section, National Institute of Neurological Disorders and Stroke, Bethesda, MarylandJosé G Merino - Stroke Diagnostics and Therapeutics Section, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland6Johns Hopkins Community Physicians, Bethesda, Maryland
- Resource Type
- Journal article
- Publication Details
- JAMA neurology, Vol.71(12), pp.1555-1558
- DOI
- 10.1001/jamaneurol.2014.2036
- PMID
- 25330362
- PMCID
- PMC5257035
- NLM abbreviation
- JAMA Neurol
- ISSN
- 2168-6149
- eISSN
- 2168-6157
- Publisher
- United States
- Grant note
- ZIA NS003043-10 / Intramural NIH HHS
- Language
- English
- Date published
- 12/2014
- Academic Unit
- Neurology; Iowa Neuroscience Institute
- Record Identifier
- 9984020608402771
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