Beneficial effects of induced hypertension on experimental stroke in awake monkeys

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✓ The authors performed a controlled study of induced hypertension therapy for treatment of experimental stroke in unanesthetized monkeys. Ten control and 10 treated animals were subjected to a 4-hour occlusion of the middle cerebral artery (MCA) by an implanted tourniquet. Neurological status and local cerebral blood flow (CBF) were monitored serially. Local CBF was determined by hydrogen clearance in and around the elevated 20% to 40% by intravenous infusion of phenylephrine hydrochloride. Neuropathological evaluation was performed after about 2 weeks.

A 4-hour occlusion of the MCA in control animals caused moderate stable neurological deficits, moderate stable decreases in local CBF, and medium-sized infarcts. With induced hypertension, five of 10 treated animals showed neurological improvement, and eight exhibited increased CBF in the ischemic zone. Average infarct size tended to be smaller in the treated group, although the difference did not reach statistical significance. Hemorrhagic infarcts were not observed. In four animals, phenylephrine caused cardiac dysrhythmias and hypotension which were reversed by appropriate measures. In this unanesthetized primate model of moderate experimental stroke, induced hypertension had beneficial effects on neurological status, local CBF, and infarct size without causing hemorrhagic infarction. Induced hypertension may be beneficial for some clinical cases of focal cerebral ischemia.

Article Information

Address for Dr. DeGirolami: Department of Pathology (Neuropathology), University of Massachusetts, Worcester, Massachusetts.

Present address for Dr. Crowell: Department of Neurological Surgery, University of Illinois College of Medicine, Chicago, Illinois.

Address reprint requests to: Daniel G. Nehls, M.D., c/o The Editorial Office, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 West Thomas Road, Phoenix, Arizona 85013.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Neurological grade, mean arterial blood pressure (MABP), and local cerebral blood flow (CBF) are presented before, during, and after occlusion in a typical treated animal. Neurological grade and local CBF deteriorated following occlusion, and improved with induced hypertension. Release of the occlusion produced further improvement parameters. Electrodes were positioned in the ischemic hemisphere with No. 1 being the most lateral and No. 5 the most medial. NEO = infusion of phenylephrine.

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    The neurological course of each animal is presented. All animals were initially neurologically normal. Occlusion produced moderate deficits in most animals. Five animals treated with hypertension improved one grade each. Episodes of hypotension (arrows) produced deterioration. With the reversal of hypotension two animals regained their improved neurological status.

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    Mean hemispheric cerebral blood flow (CBF) is presented as percent of preocclusion blood flow for treated and control animals. The CBF increased in the animals treated with induced hypertension. However, CBF decreased below occlusion values in the group of four animals in which hypotension developed (square datum point).

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