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Stroke Prognosis: Monitoring the Hemodynamics and Blood Pressure by TCD/TCCS

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Neurosonology in Critical Care

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Abstract

Acute ischemic stroke is essentially a hemodynamic event: It is triggered by a vascular occlusion and the current mainstay of treatment is reopening the culprit vessel using endovascular procedures and/or thrombolysis. Despite this oversimplistic view, concealing overwhelming cellular, intercellular, inflammatory, and hypoxic mechanisms, it is widely accepted that cerebral hemodynamics is a major determinant, and the only that can be effectively modulated. However, each patient shows their own hemodynamic evolution at different time points, underscoring the need for neurosonologic assessments to accurately evaluate patients and be safely repeated overtime.

The early determinants of injury are site of vessel occlusion and activation of collateral circulation; after recanalization, a state of hypo, normal, or hyperperfusion may occur with different implications in the management of blood pressure and posture.

In this chapter, we will present an integrated clinical neurosonological approach to stroke hemodynamics and how these mechanisms can be assessed and clinically modulated.

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Author information

Authors and Affiliations

  1. Neurosonology Laboratory, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

    Ricardo Varela, José Coelho, Sara Bernardo-Castro, Fernando Silva & João Sargento-Freitas

  2. Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal

    Sara Bernardo-Castro & João Sargento-Freitas

  3. Committee Member - ESNCH, Oslo, Norway

    João Sargento-Freitas

Authors
  1. Ricardo Varela
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  2. José Coelho
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  3. Sara Bernardo-Castro
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  4. Fernando Silva
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  5. João Sargento-Freitas
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Corresponding author

Correspondence to João Sargento-Freitas .

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Editors and Affiliations

  1. Department of Critical Care, University of Buenos Aires, Buenos Aires, Argentina

    Camilo N. Rodríguez

  2. Stroke Unit & Neurosonology Lab, University of Padua School of Medicine, Padova, Italy

    Claudio Baracchini

  3. Department of Critical Care and Anesthesiology, Fundación Valle del Lili, Cali, Colombia

    Jorge H. Mejia-Mantilla

  4. Department of Clinical Neurosciences Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK

    Marek Czosnyka

  5. Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Jose I Suarez

  6. President of Hungarian Neurological Society, Department of Neurology, Clinical Center Debrecen University, Debrecen, Hungary

    László Csiba

  7. Intensive Care Unit, Clinics Hospital, Universidad de la Republica School of Medicine, Montevideo, Uruguay

    Corina Puppo

  8. Center for Neurological Vascular Diagnostics, Munich, Germany

    Eva Bartels

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Varela, R., Coelho, J., Bernardo-Castro, S., Silva, F., Sargento-Freitas, J. (2022). Stroke Prognosis: Monitoring the Hemodynamics and Blood Pressure by TCD/TCCS. In: Rodríguez, C.N., et al. Neurosonology in Critical Care . Springer, Cham. https://doi.org/10.1007/978-3-030-81419-9_30

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  • DOI: https://doi.org/10.1007/978-3-030-81419-9_30

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