Sonographic Demonstration of a Perfusion-Dependent Stroke with Negative MRI and a Flow-Limiting Stenosis

Excerpt

Perfusion dependence of stroke is a phenomenon often investigated in an acute ischemic stroke caused by large vessel occlusion while patients are being evaluated for endovascular interventions. Perfusion-dependent ischemia poses several management challenges before or after management of large vessel occlusion. While induced hypertension can augment cerebral perfusion prior to recanalization, reperfusion injury after recanalization can cause cerebral edema and hemorrhage [1‐3]. Partially recanalized patients may still need some degree of permissive hypertension to optimize cerebral perfusion. Hemodynamic parameters on ultrasound may guide optimal blood pressure targets in such patients [4, 5]. We present a case of a patient who had flow-limiting lesions causing neurological symptoms, with a magnetic resonance imaging (MRI) unremarkable for restricted diffusion, who experienced symptomatic improvement after permissive hypertension. We observed this change in cerebral perfusion with transcranial Doppler (TCD) when systemic perfusion was augmented. …