Gavito-Higuera J, Khatri R, Qureshi IA, Maud A, Rodriguez GJ. Aggressive blood pressure treatment of hypertensive intracerebral hemorrhage may lead to global cerebral hypoperfusion: Case report and imaging perspective. World J Radiol 2017; 9(12): 448-453 [PMID: 29354210 DOI: 10.4329/wjr.v9.i12.448]
Corresponding Author of This Article
Rakesh Khatri, MD, Assistant Professor, Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University of Health Sciences Center, 5001 El Paso Drive, El Paso, TX 79905, United States. rakesh.khatri@ttuhsc.edu
Research Domain of This Article
Radiology, Nuclear Medicine & Medical Imaging
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Radiol. Dec 28, 2017; 9(12): 448-453 Published online Dec 28, 2017. doi: 10.4329/wjr.v9.i12.448
Aggressive blood pressure treatment of hypertensive intracerebral hemorrhage may lead to global cerebral hypoperfusion: Case report and imaging perspective
Jose Gavito-Higuera, Rakesh Khatri, Ihtesham A Qureshi, Alberto Maud, Gustavo J Rodriguez
Jose Gavito-Higuera, Rakesh Khatri, Ihtesham A Qureshi, Alberto Maud, Gustavo J Rodriguez, Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University of Health Sciences Center, El Paso, TX 79905, United States
Author contributions: All authors contributed equally.
Informed consent statement: Informed consent was obtained from the family of the patient for the purpose of publication.
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Rakesh Khatri, MD, Assistant Professor, Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University of Health Sciences Center, 5001 El Paso Drive, El Paso, TX 79905, United States. rakesh.khatri@ttuhsc.edu
Telephone: +1-915-2155900 Fax: +1-915-5456705
Received: February 8, 2017 Peer-review started: February 12, 2017 First decision: May 17, 2017 Revised: August 22, 2017 Accepted: November 29, 2017 Article in press: November 29, 2017 Published online: December 28, 2017 Processing time: 320 Days and 23.1 Hours
Abstract
Hypoperfusion injury related to blood pressure decrease in acute hypertensive intracerebral hemorrhage continues to be a controversial topic. Aggressive treatment is provided with the intent to stop the ongoing bleeding. However, there may be additional factors, including autoregulation and increased intracranial pressure, that may limit this approach. We present here a case of acute hypertensive intracerebral hemorrhage, in which aggressive blood pressure management to levels within the normal range led to global cerebral ischemia within multiple border zones. Global cerebral ischemia may be of concern in the management of hypertensive hemorrhage in the presence of premorbid poorly controlled blood pressure and increased intracranial pressure.
Core tip: The current case report highlights the risk of aggressive management of acute hypertension in the setting of intracerebral hemorrhage causing global cerebral hypoperfusion, despite maintenance of cerebral perfusion pressure above the lower threshold of autoregulation. The authors suggest the use of accurate method to measure cerebral oxygenation, such as brain-tissue oxygen monitoring, which could help individualize aggressive blood pressure control in patients with acute hypertensive intracerebral hemorrhage.