Is there a good rationale for using vasopressors/induced hypertension in a patient with fluctuating neurologic deficits from symptomatic intracranial stenosis?
Answer from: at Academic Institution
I have raised blood pressure in patients with fluctuating stroke deficits, especially in patients with intracranial hypertension, with apparently good results. We usually try fluids first, but pressors are sometimes necessary. This makes sense from the known autoregulation curves, which are shifted ...
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Answer from: at Community Practice
If typical measures (such as IV fluids, bed rest, and laying flat) fail to resolve the issue, it's reasonable to proceed with a vasopressor (typically norepinephrine), for 48-72 hours to augment flow to the affected territory. In refractory cases, we may consider an intracranial stent as a rescue op...
Answer from: at Academic Institution
In these cases, we will augment the SBP or MAP by 10-20% to see if there is a response. There is a series of small trials showing that this is safe. Once the blood pressure goal is met, we will keep it there for several hours and if there is no change in the patients exam, we will stop it. If the ex...