Horizontal position optimal for perfusion in stroke patients

NEW YORK (Reuters Health) – In patients with large hemispheric strokes, maximal cerebral perfusion pressure is achieved with horizontal body positioning, according to a report published in the February issue of Stroke: Journal of the American Heart Association.

Dr. Stefan Schwarz, and colleagues from the University of Heidelberg in Germany, assessed the intracranial hemodynamics of 18 patients with an acute complete or subtotal middle cerebral artery territory stroke. None of the patients had an acute intracranial pressure crisis.

Mean arterial pressure in the horizontal position was 90 mm Hg, and this decreased significantly with each 15-degree increase in backrest elevation (p < 0.0001). The intracranial pressure also decreased as elevation increased, but because the reductions did not keep pace with those of the mean arterial pressure, the cerebral perfusion pressure also decreased as elevation increased.

Middle cerebral artery peak mean flow velocity decreased with backrest elevation. Elevation had a greater impact on flow velocity on the side contralateral to the stroke than ipsilateral, the investigators note.

"If adequate cerebral perfusion pressure is considered more desirable than the absolute level of intracranial pressure, the horizontal position is optimal" for patients with large hemispheric strokes, the authors state. "In those few patients in whom intracranial pressure rises substantially in a flat position, moderate backrest elevation may be the better choice."

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