Aggressive blood pressure treatment of hypertensive intracerebral hemorrhage may lead to global cerebral hypoperfusion: Case report and imaging perspective

Abstract

Hypoperfusion injury related to blood pressure decrease in acute hypertensive intracerebral hemorrhage continues to be a controversial topic. Aggressive treatment is provided with the intent to stop the ongoing bleeding. However, there may be additional factors, including autoregulation and increased intracranial pressure, that may limit this approach. We present here a case of acute hypertensive intracerebral hemorrhage, in which aggressive blood pressure management to levels within the normal range led to global cerebral ischemia within multiple border zones. Global cerebral ischemia may be of concern in the management of hypertensive hemorrhage in the presence of premorbid poorly controlled blood pressure and increased intracranial pressure.

Keywords: Intracranial hemorrhage; Neurocritial care; Stroke management; Perihematoma ischemia

Core tip: The current case report highlights the risk of aggressive management of acute hypertension in the setting of intracerebral hemorrhage causing global cerebral hypoperfusion, despite maintenance of cerebral perfusion pressure above the lower threshold of autoregulation. The authors suggest the use of accurate method to measure cerebral oxygenation, such as brain-tissue oxygen monitoring, which could help individualize aggressive blood pressure control in patients with acute hypertensive intracerebral hemorrhage.