Induced hypervolemia and inotropic support for acute cerebral arterial insufficiency: an underused therapy.

BACKGROUND

Hypervolemia and induced systemic hypertension are generally considered the standard approach to the treatment of vasospasm. Despite evidence in favor of its efficacy, this therapy is used rarely in acute cerebrovascular occlusion. We present a case supporting this treatment paradigm.

CASE DESCRIPTION: A patient developed aphasia and hemiplegia 8 h after carotid endarterectomy caused by embolic occlusion of the middle cerebral artery. Hyperdynamic/hypervolemic therapy was instituted. Serial angiograms filmed over the next 8 h demonstrated reperfusion of the hemisphere, through collateral flow. The patient's symptoms resolved.

CONCLUSIONS

We believe this case demonstrates the effectiveness of hypervolemia and inotropic support in the treatment of acute embolic stroke by inducing dilatation of the leptomeningeal collateral circulation.