Hemorrhagic transformation and cerebral edema in acute ischemic stroke: Link to cerebral autoregulation

• Type: Article in International Scientific Journal
• Date: 2017

Authors

Pedro Castro (Author) FMUP; Elsa Azevedo (Author) FMUP; Serrador, J (Author) Other; Rocha, I (Author) Other; Sorond, F (Author) Other

Journal

Title: Journal of the Neurological Sciences

Vol. 372

Pages: 256-261

ISSN: 0022-510X

Publisher: Elsevier

Indexing

ISI Web of Knowledge - 74 Citations

Scopus - 82 Citations

Other information

Authenticus ID: P-00M-G6N

DOI: 10.1016/j.jns.2016.11.065

Abstract (EN): Background: Hemorrhagic transformation and cerebral edema are feared complications of acute ischemic stroke but mechanisms are poorly understood and reliable early markers are lacking. Early assessment of cerebrovascular hemodynamics may advance our knowledge in both areas. We examined the relationship between dynamic cerebral autoregulation (CA) in the early hours post ischemia, and the risk of developing hemorrhagic transformation and cerebral edema at 24 h post stroke Methods: We prospectively enrolled 46 patients from our center with acute ischemic stroke in the middle cerebral artery territory. Cerebrovascular resistance index was calculated. Dynamic CA was assessed by transfer function analysis (coherence, phase and gain) of the spontaneous blood flow velocity and blood pressure oscillations. Infarct volume, hemorrhagic transformation, cerebral edema, and white matter changes were collected from computed tomography performed at presentation and 24 h. Results: At admission, phase was lower (worse CA) in patients with hemorrhagic transformation [6.6 +/- 30 versus 45 +/- 38 degrees; adjusted odds ratio 0.95 (95% confidence internal 0.94-0.98), p = 0.023] and with cerebral edema [6.6 30 versus 45 38, adjusted odds ratio 0.96 (0.92-0.999), p = 0.044]. Progression to edema was associated with lower cerebrovascular resistance (1.4 +/- 0.2 versus 2.3 +/- 1.5 mm Hg/cm/s, p = 0.033) and increased cerebral blood flow velocity (51 +/- 25 versus 42 +/- 17 cm/s, p = 0.033) at presentation. All hemodynamic differences resolved at 3 months Conclusions: Less effective CA in the early hour post ischemic stroke is associated with increased risk of hemorrhagic transformation and cerebral edema, possibly reflecting breakthrough hyperperfusion and microvascular injury. Early assessment of dynamic CA could be useful in identifying individuals at risk for these complications.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 6