This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Abstract
Background: Acute stroke patients are routinely positioned with the head of the bed (HOB) elevated at 30° despite lack of evidence for increased intracranial pressure.
Objectives: To determine the effect of HOB positions in real time on residual blood flow velocity in acutely occluded arteries causing stroke and whether resistance to residual flow increased with lower HOB positions.
Methods: In a repeated-measures quasi-experiment, the effect of 30, 15, and 0° HOB on middle cerebral artery (MCA) mean flow velocity (MFV) in patients with acute (<24 hours) ischemic stroke was measured with transcranial Doppler using MFV and pulsatility index (PI) of the residual flow signals at the site of persisting acute occlusion.
Results: Twenty patients were evaluated (mean age 60 ± 15 years; median NIH Stroke Scale [NIHSS] score 14 points). MCA MFV increased in all patients with lowering head position (maximum absolute MFV value increase 27 cm/s, range 5 to 96% from baseline values at 30°). On average, MCA MFV increased 20% (12% from 30 to 15° and 8% from 15 to 0°; p ≤ 0.025). Mean arterial pressure and heart rate were unchanged throughout the intervention. PI remained unchanged (mean values 0.89 at 30° elevation, 0.91 at 15° elevation, and 0.83 at 0° elevation) at each HOB position, indicating no increase in resistance to blood flow. Immediate neurologic improvement (average 3 NIHSS motor points) occurred in three patients (15%) after lowering head position.
Conclusion: Acute ischemic stroke patients may benefit from lower head-of-the-bed positions to promote residual blood flow to ischemic brain tissue.
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
Letters: Rapid online correspondence
- Heads down: Flat positioning improves blood flow velocity in acute ischemic stroke
- Reply to de Paula
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
You May Also be Interested in
Alert Me
Recommended articles
Therapeutic-induced hypertension in patients with noncardioembolic acute stroke
Involvement of the healthy hemisphere in recovery from aphasia and motor deficit in patients with cortical ischemic infarction
Association of reversed Robin Hood syndrome with risk of stroke recurrence
Periprocedural management of acute ischemic stroke intervention