Blanca Fuentes1, Exuperio Díez-Tejedor. 1. Stroke Unit, Department of Neurology, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain.
Abstract
INTRODUCTION: Several studies have highlighted that the appropriate control of blood pressure, glycemia, body temperature and oxygen saturation is correlated with the clinical evolution of acute stroke when each of these variables is analyzed separately. However, within a biological system all these parameters can be interrelated and can influence the process. Recent studies demonstrate the importance of appropriate maintenance of these variables in what is termed nonpharmacological brain protection. METHODS: We conducted a review of the published studies that analyze the influence of the control of these physiological variables in acute stroke, not only in isolation, with specific attention to glycemia and blood pressure, but also in combination. Homeostasis was considered the normalization of these variables. RESULTS: Over the past few years several studies have demonstrated the influence of hyperglycemia and blood pressure changes in the acute phase of stroke on the prognosis of the patients. Recent studies highlight that glucose values >150 mg/dl and systolic blood pressure >180 mm Hg indicate poorer prognosis. However, there are insufficient data on whether pharmacological correction of the variables influences the prognosis. Nevertheless, when these variables are analyzed in combination, the patients in whom the variables are maintained within normality (homeostasis) have a better prognosis. Stroke units are the ideal locations for the application of these treatments. CONCLUSIONS: Nonpharmacological brain protection, with the appropriate maintenance of homeostasis, constitutes the basis for optimum treatment of acute stroke. Copyright 2007 S. Karger AG, Basel.
INTRODUCTION: Several studies have highlighted that the appropriate control of blood pressure, glycemia, body temperature and oxygen saturation is correlated with the clinical evolution of acute stroke when each of these variables is analyzed separately. However, within a biological system all these parameters can be interrelated and can influence the process. Recent studies demonstrate the importance of appropriate maintenance of these variables in what is termed nonpharmacological brain protection. METHODS: We conducted a review of the published studies that analyze the influence of the control of these physiological variables in acute stroke, not only in isolation, with specific attention to glycemia and blood pressure, but also in combination. Homeostasis was considered the normalization of these variables. RESULTS: Over the past few years several studies have demonstrated the influence of hyperglycemia and blood pressure changes in the acute phase of stroke on the prognosis of the patients. Recent studies highlight that glucose values >150 mg/dl and systolic blood pressure >180 mm Hg indicate poorer prognosis. However, there are insufficient data on whether pharmacological correction of the variables influences the prognosis. Nevertheless, when these variables are analyzed in combination, the patients in whom the variables are maintained within normality (homeostasis) have a better prognosis. Stroke units are the ideal locations for the application of these treatments. CONCLUSIONS: Nonpharmacological brain protection, with the appropriate maintenance of homeostasis, constitutes the basis for optimum treatment of acute stroke. Copyright 2007 S. Karger AG, Basel.