Early changes in physiological variables after stroke
Open Access
- 1 January 2008
- journal article
- review article
- Published by Medknow in Annals of Indian Academy of Neurology
- Vol. 11 (4), 207-220
- https://doi.org/10.4103/0972-2327.44555
Abstract
Several aspects of physiology, notably blood pressure, body temperature, blood glucose, and blood oxygen saturation, may be altered after an ischemic stroke and intracerebral hemorrhage. Generally, blood pressure and temperature rise acutely after a stroke, before returning to normal. Blood glucose and oxygen levels may be abnormal in individuals, but they do not follow a set pattern. Several aspects of these physiological alterations remain unclear, including their principal determinants - whether they genuinely affect prognosis (as opposed to merely representing underlying processes such as inflammation or a stress response), whether these effects are adaptive or maladaptive, whether the effects are specific to certain subgroups (e.g. lacunar stroke) and whether modifying physiology also modifies its prognostic effect. Hypertension and hyperglycemia may be helpful or harmful, depending on the perfusion status after an ischemic stroke; the therapeutic response to their lowering may be correspondingly variable. Hypothermia may provide benefits, in addition to preventing harm through protection from hyperthermia. Hypoxia is harmful, but normobaric hyperoxia is unhelpful or even harmful in normoxic patients. Hyperbaric hyperoxia, however, may be beneficial, though this remains unproven. The above-mentioned uncertainties necessitate generally conservative measures for physiology management, although there are notably specific recommendations for thrombolysis-eligible patients. Stroke unit care is associated with better outcome, possibly through better management of poststroke physiology. Stroke units can also facilitate research to clarify the relationship between physiology and prognosis, and to subsequently clarify management guidelines.Keywords
This publication has 104 references indexed in Scilit:
- Acetylsalicylic Acid and Acetaminophen to Combat Elevated Body Temperature in Acute Ischemic StrokeCerebrovascular Diseases, 2003
- Association Between Blood Pressure and C-Reactive Protein Levels in Acute Ischemic StrokeHypertension, 2003
- Association between course of blood pressure within the first 24 hours and functional recovery after acute ischemic strokeAnnals of Emergency Medicine, 2003
- Effects of Admission Hyperglycemia on Stroke Outcome in Reperfused Tissue Plasminogen Activator–Treated PatientsStroke, 2003
- Dynamic But Not Static Cerebral Autoregulation Is Impaired in Acute Ischaemic StrokeCerebrovascular Diseases, 2000
- Acute Infection as a Risk Factor for Ischemic StrokeStroke, 1996
- Changes of circadian blood pressure patterns after hemodynamic and thromboembolic brain infarction.Stroke, 1994
- Factors affecting changes in blood pressure after acute stroke.Stroke, 1994
- Hyperbaric oxygenation as an adjunct therapy in strokes due to thrombosis. A review of 122 patients.Stroke, 1980
- The Use of Hyperbaric Oxygenation in the Treatment of Cerebral Ischemia and InfarctionCirculation, 1966