1994 Volume 17 Issue SupplementI Pages S71-S76
The control of blood pressure in acute stroke patients and management of hypertension in chronic stroke patients are highly important. So we attempted to clarify the clinical significance of cerebral blood flow (CBF) autoregulation in stroke patients. 1) Orthostatic hypotension in early rehabilitation: The incidence of neurological symptoms decreased when the head of the bed was elevated gradually, over days, rather than rapidly. The results indicate that a gradual elevation of the head of the bed in stepwise fashion is safer than an abrupt elevation, especially in patients with occlusions of the main cerebral artery. 2) CBF autoregulation in patients with acute brain hemorrhage: Blood pressure control is essential in managing patients with acute brain hemorrhage. Measurements of CBF autoregulation in cases wlth acute brain hemorrhage indicate that a 20% reduction in blood pressure is the maximum for maintaining cerebral circulation. 3) CBF autoregulation in patients of chronic brain infarction: The reduction of blood pressure in hypertensive patients with ischemic cerebrovascular disease should be within 20% in those without arterial occlusion, and within 10% in those with a stem occlusion of the middle cerebral artery. 4) Periventricular lucency (PVL) and CBF autoregulation: Mean cerebrovascular resistance value was elevated in chronic hypertensive patients with CT findings of severe PVL; cases of severe PVL also showed impaired CBF autoregulation. This indicates that hypertensive patients whose brain CT reveal severe PVL have an impaired CBF autoregulation. In these cases a strict regimen for lowering the blood pressure is required to prevent deterioration of the cerebral microcirculation. (Hypertens Res 1994; 17 Suppl. I: S71-S76)
