Under pressure: pressure-dependent pontine compression by a dolichoectasia basilar artery, a case report

2021 ◽  
pp. 197140092110177
Author(s):  
Alfonso E Martinez-Nunez ◽  
Julie E Fynke ◽  
Daniel J Miller
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Case Report ◽  
Blood Pressure Control ◽  
Basilar Artery ◽  
Pulse Pressure ◽  
Complete Resolution ◽  
Hypertensive Crisis ◽  
Pressure Control ◽  
Ventral Surface

Basilar artery dolichoectasia can lead to ischemic stroke through thrombosis of small perforating vessels of the brainstem. Here we report the case of a patient with transient paramedian pontine syndrome in the setting of a hypertensive crisis, finding a dolichoectasia basilar artery compressing on the ventral surface of the pons. The outcome was near-complete resolution of deficits after blood pressure control. We propose increased basilar artery pulse pressure as a novel mechanism of transient compression of the brainstem by a dolichoectasia artery.

scholarly journals Blood pressure control in private practice: a case report.

1979 ◽  
Vol 69 (1) ◽  
pp. 25-29 ◽  
Author(s):  
A L Engelland ◽  
M H Alderman ◽  
H B Powell
Keyword(s):  
Blood Pressure ◽  
Case Report ◽  
Blood Pressure Control ◽  
Private Practice ◽  
Pressure Control

Abstract TMP56: Prediction of Primary Stroke: A Secondary Analysis of the SPRINT Trial

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Adam H de Havenon ◽  
Eric Goldstein ◽  
Stephanie Lyden ◽  
Jennifer Majersik
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Blood Pressure Control ◽  
Primary Outcome ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Blood Pressure Reduction ◽  
Pressure Control ◽  
Significant Difference ◽  
History Of

Background: The Systolic Blood Pressure Intervention Trial enrolled patients aged 50 or older with at least one cardiovascular disease risk factor, but free of prior symptomatic stroke. Patients were assigned to two blood pressure reduction goals (<140 versus 120 mm Hg). There was not a significant difference in the rate of stroke, making this an ideal cohort to refine risk prediction of primary stroke, which is understudied in patients with adequate blood pressure control and a rigorously adjudicated outcome of stroke. Methods: The primary outcome is ischemic stroke. We fit Cox models to the primary outcome and evaluated all baseline demographic variables to determine which would be most predictive of stroke, which we then used to create a prediction score. Results: We included 9,361 patients with a mean (SD) age of 67.9 (9.4) years and 171 (1.8%) patients met the primary outcome of stroke. For our prediction model, we gave one point each for history of TIA, atrial fibrillation, congestive heart failure, or diabetes. Patients with 2 or more points were collapsed, making three possible scores of 0, 1, and 2, which had rates of stroke of 1.5% (117/8042), 3.2% (30/933), and 6.2% (24/386) (p<0.001). Compared to a score of 0, the hazard ratios for stroke of score 1 and 2 were 2.3 (95% CI, 1.6-3.5) and 4.6 (95% CI, 2.9-7.1) (both p<0.001) (Figure 1). Conclusion: A simple scoring system can improve prediction of ischemic stroke from 1.8% to 6.2% in patients with no prior history of stroke and excellent blood pressure control. This information could be used to improve patient selection for clinical trials or for identifying patients for more aggressive primary prevention strategies.

Intensive blood pressure control may not be safe in subacute ischemic stroke by intracranial atherosclerosis

2018 ◽  
Vol 36 (9) ◽  
pp. 1936-1941 ◽  
Author(s):  
Jong-Moo Park ◽  
Bum Joon Kim ◽  
Sun U. Kwon ◽  
Yang-Ha Hwang ◽  
Sung Hyuk Heo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Intracranial Atherosclerosis ◽  
Intensive Blood Pressure

Survey of blood pressure control status in patients with ischemic stroke or transient ischemic attack in China

2008 ◽  
Vol 30 (4) ◽  
pp. 348-355 ◽  
Author(s):  
Yilong Wang ◽  
Di Wu ◽  
Yong Zhou ◽  
Xingquan Zhao ◽  
Chunxue Wang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Blood Pressure Control ◽  
Transient Ischemic Attack ◽  
Pressure Control ◽  
Ischemic Attack

scholarly journals Prevalence of Inadequate Blood Pressure Control Among Veterans After Acute Ischemic Stroke Hospitalization

2011 ◽  
Vol 4 (4) ◽  
pp. 399-407 ◽  
Author(s):  
Christianne L. Roumie ◽  
Susan Ofner ◽  
Joseph S. Ross ◽  
Greg Arling ◽  
Linda S. Williams ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Blood Pressure Control ◽  
Pressure Control

scholarly journals MON-205 Effectiveness of Pre-Op α-Blockade on Intra-Op Blood Pressure Control in Patients with Pheochromocytoma

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Julia Caroline Wingate Lake ◽  
Richard J Comi
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Cumulative Dose ◽  
Hypertensive Crisis ◽  
Pressure Control ◽  
Volume Replacement ◽  
Perioperative Outcomes ◽  
Preoperative Treatment ◽  
Blood Pressure Lowering ◽  
Pressure Lowering

Abstract Pheochromocytoma are rare tumors arising from catecholamine producing chromaffin tissue. Surgical manipulation of pheochromocytoma inevitably leads to supraphysiologic levels of circulating catecholamines. Such manipulation has the potential to lead to an intra-operative hypertensive crisis, cardiac arrhythmia, myocardial infarction, or pulmonary edema. When inadequately primed pre-operatively, a patient exposed to such surges may experience life-threatening consequences. Phenoxybenzamine is a non-competitive, non-selective α 1 and α 2 receptor antagonist that prevents blood pressure liability during surgical resection of pheochromocytoma. Previous literature has suggested that phenoxybenzamine affords more pronounced peri-operative systolic blood pressure control as compared to selective alpha-blockers. This superior control potentially is at the cost of postoperative hypotension owing to the irreversible nature of phenoxybenzamine.1 Our study compares the effects of pre-operative phenoxybenzamine on perioperative outcomes at a single tertiary medical center from 2004 to 2019. The cumulative pre-operative phenoxybenzamine dose was compared to the maximum intra-operative blood pressure, need for IV blood pressure lowering medications, duration of vasopressor need, volume replacement need, duration of time in the OR, duration of hospital stay, and pre-operative catecholamine levels. We speculate that increased phenoxybenzamine exposure will result in reduced peak intra-operative blood pressure and need for IV blood pressure lowering medications but may increase the need for post-resection intra-operative vasopressors and post-resection volume replacement. After IRB approval, (ID #00031606), we performed a data warehouse query for the ICD 9 and 10 codes of “pheochromocytoma” and “paraganglioma”. Patients who did not have confirmed pheochromocytoma on pathology were excluded. Data was collected retrospectively on 30 patients who underwent adrenalectomy for pheochromocytoma. 14 charts were excluded due to incomplete intra-operative anesthetic documentation. Our results suggest that there is no significant correlation between peak intra-operative MAP and cumulative phenoxybenzamine exposure. The cumulative dose of pre-operative phenoxybenzamine did not correlate with the number of anti-hypertensive medications used intra-operatively. An increased cumulative dose of pre-operative phenoxybenzamine was not associated with an increased duration of intra-operative vasopressor medications. Intra-operative volume replacement needs were surprisingly reduced with increased cumulative pre-operative phenoxybenzamine exposure. 1 P.A. van der Zee, A. de Boer. Pheochromocytoma: A review on preoperative treatment with phenoxybenzamine or doxazosin. The Netherlands Journal of Medicine. May 2014; Vol. 72 No 4, 190-201.

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