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Acute Stroke
Mursyid Bustami
Neurology Department
University of Indonesia
Background
Stroke, 1986;17:861-64 .
Hypertension in Acute Stroke
SBP >140 mmHg; 81,6% (IST,2002) SBP >140 mmHg; 77,8% (BASC,2001)
Dead
• Every 10 mmHg
decreased in SBP < 150
mmHg; mortality rate
increased by 17.5%
• Every 10 mmHg
increased in SBP > 150
mmHg; mortality rate
increased by 3.8%
Dead
Every 10 mmHg
increased in SBP > 180
mmHg:
• Risk of neurological
status deterioration
increased by 40%
• Risk of poor outcome
increased by 23%
Recurrent
Every 10 mmHg
decreased in SBP <
150 mmHg; risk of
ischemic stroke
recurrence in 14 days
increased by 14.2 %
• Primary Injury:
area of maximum neuronal
damage.
• Penumbra:
area of less injured and
potentially recoverable neuronal
tissue
• Secondary injury:
follows primary injury and
causes further neuronal damage.
Autoregulation
Normal :
– CPP 70 – 100 mmHg.
– CBF remains 50 ml/
100mg tissue/min ~
CPP 40 - 140 mm Hg
AUTOREGULATION
Impaired AUTOREGULATION
CBF
CBF = CPP/CVR
CPP = MAP - ICP
Normal
CPP
Chronic Hypertension
Reasons not to treat hypertension
CBF
(ml/100g/min)
Normal flow,
normal neuronal function
50
20 Reversible
Deficit
Penumbra Irreversible reduced
function, i.e. infarction
0 1 2 3
Time passing (hours)
Reasons not to treat hypertension
The Facts
• Every 10% decreased of BP in the first
day of stroke attack will increased the
likelihood of poor clinical outcome (OR
1,89)
Oliveira-Filha et al. Neurology 2003:1047-51