好色先生

好色先生

Explore the latest content from across our publications

Log In

Forgot Password?
Create New Account

Loading... please wait

Abstract Details

Case Report: Sonographic demonstration of a perfusion dependent stroke with negative MRI and a flow limiting stenosis
Cerebrovascular Disease and Interventional Neurology
P6 - Poster Session 6 (11:30 AM-1:00 PM)
15-028

Introduction: Perfusion dependence is observed in acute ischemic stroke caused by large vessel occlusion.  We present a case of a patient with flow limiting lesions causing neurological symptoms, with a negative MRI, and symptomatic improvement after permissive hypertension.  

NA

Case: 67-year-old male presented with focal symptoms and an NIHSS of 8.  He was past the time window, so tPA was not given.  CT angiogram/perfusion revealed occlusion of the right ICA bifurcation and multifocal intracranial stenoses.  Cerebral angiography showed occlusion of the R ICA distal to the origin with reconstitution from the ECA through the ophthalmic, and non-filling of the ACA. Mechanical thrombectomy was performed, and TICI 3 achieved in the R ICA.  Post-procedural NIHSS score was 8.  Right MCA symptoms continued despite complete recanalization. Nicardipine was initiated to target systolic blood pressure (SBP) <160. MRI done during symptoms was normal. BP remained in the 150s. Bedside point of care TCD showed lower right MCA velocities suggesting relative hypoperfusion vs left MCA. This was confirmed by clinical TCD, when BP in the left arm was 142/65 mmHg. The nicardipine was stopped, and BP rose to 160-170 mmHg, without much clinical improvement. When SBP reached the 180s-200s symptoms rapidly improved. Repeat TCD showed improved R MCA and ACA velocities.  Repeat NIHSS score was 2, but there were no persisting symptoms the next day. Oral antihypertensive was started and titrated to a BP of 160-180 mmHg, with discharge on day 3, with NIHSS score of 0.

NA

This patient demonstrated TCD evidence of a perfusion dependent MRI negative stroke that responded to systemic perfusion augmentation. TCD may help identify the problem and inform treatment for such patients.  Future studies assessing target BP in large vessel strokes should employ use of noninvasive strategies like TCD in acute evaluation, management and follow up of stroke. 

Authors/Disclosures

PRESENTER
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
Charles H. Tegeler, MD (Wake Forest School of Medicine) Dr. Tegeler has nothing to disclose.
Aarti Sarwal, MD, FAAN (Medical Center Blvd) Dr. Sarwal has received personal compensation in the range of $0-$499 for serving as a Consultant for Stimdia, Inc. Dr. Sarwal has received personal compensation in the range of $0-$499 for serving as a Consultant for Sheinkei. Dr. Sarwal has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Critical Care Medicine. Dr. Sarwal has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for PMID: 29881956. Dr. Sarwal has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Society of Neuroimaging . The institution of Dr. Sarwal has received research support from Butterfly, Inc. The institution of Dr. Sarwal has received research support from Bard. The institution of Dr. Sarwal has received research support from Biogen. The institution of Dr. Sarwal has received research support from Novartis. The institution of Dr. Sarwal has received research support from CVR Global. The institution of Dr. Sarwal has received research support from NIH/NIA R01 AG066910-01 . The institution of Dr. Sarwal has received research support from Image Monitoring. Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a Speaker/Faculty, CME courses with Society of Critical Care Medicine . Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a Speaker at annual congress with Intensive Care Society. Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a Speaker at annual congress with Indian Society of Critical Care. Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a speaker/Faculty for Annual meeting, travel compensation with European Society of Intensive Care Medicine. Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a Speaker with ISICEM. Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a Associate Editor, Clinical Neuroimaging with American Society of Neuroimaging . Dr. Sarwal has a non-compensated relationship as a Social Media Editor with Neurocritical Care that is relevant to AAN interests or activities. Dr. Sarwal has a non-compensated relationship as a Board of Directors with American Society of Neuroimaging that is relevant to AAN interests or activities. Dr. Sarwal has a non-compensated relationship as a President with Association of Indian Neurologists in America that is relevant to AAN interests or activities.