Cerebrovascular blood pressure management

Blood Pressure Management in the Setting of an Acute Cerebrovascular Accident... 

Patients with malignant-accelerated hypertension can usually be managed by oral therapy. Patients who are seen in a nursing home or clinic, whose BP is found to be above some arbitrary danger level like a BP of 180/120 should not automatically be given nifedipine sublingually. Indiscriminate use of nifedipine sublingually could lead to a major catastrophe like myocardial infarction or cerebrovascular episodes. Nifedipine activates sympathetic response and leads to precipitous drops of blood pressure followed by rebound hypertension. 

Bath FJ, Bath PMW (1997). What is the correct management of blood pressure in acute stroke The Blood Pressure in Acute Stroke Collaboration. Cerebrovascular Diseases 7 205-213... 

Hypothermia extends the survival time and prevents the development of brain edema in rats with ALE, caused by hepatic devascularization and mild hypothermia (33—35°C), reduces ammonia-induced brain swelling and increased intracranial pressure in portacaval-shunted rats administered ammonium salts. These findings have led to the successful use of mild hypothennia for the treatment of uncontrolled intracranial hypertension in patients with ALF (Jalan et al., 1999). Mechanisms so far identified that underhe the beneficial effect of hypothermia in ALF include reduced blood-brain transfer of ammonia, improved cerebrovascular hemodynamics and normafization of extracellular brain amino acid patterns (for review of these mechanisms, see Vaquero et al., 2005). Mild hypothermia also improves hepatic function in experimental toxic fiver injury (Vaquero et al., 2(X)7) Mild-to-moderate hypothermia has the potential to serve as an important strategy in the management of patients with ALF awaiting liver transplantation. 

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