Haemodynamic stroke: Management and Prognosis
Compromising the haemodynamic status due for example to heart failure and hypotension can lead to signs and symptoms of a stroke.
A new review article by the Lancet Neurology was published on line of the October 2010 issue of the Journal (The Lancet Neurology 9;10: 1008-1017). Severe obstruction of the carotid or vertebral arteries was mentioned as a cause of a haemodynamic stroke as well.
It becomes clear from the clinical practice that patients with haemodynamic stroke or transient ischaemic attack might show specific clinical features that distinguish them from patients with embolism or local small-vessel disease. Ancillary investigations of cerebral perfusion can show whether blood flow to the brain is compromised and provide important prognostic information as the review article suggested. Management of patients who have hypoperfusion as the major cause of ischaemic stroke or as a contributing factor is hampered by the lack of clinical trials. The authors mentioned that treatment aimed at increasing cerebral blood flow might be considered in selected patients on the basis of information from case series. The Review article concluded that further research is needed to define criteria for the diagnosis of haemodynamic stroke and to investigate treatment options in controlled studies.