Head Position Guides Stroke Treatment

A simple maneuver can help guide management decisions in patients undergoing acute ischemic stroke with minimal initial deficits, despite persisting large artery occlusion.

Patients with acute ischemic stroke with large vessel occlusion sometimes show clinical improvements several hours after stroke onset, making physicians uncertain if they should pursue recanalization therapy or not. With the aid of a simple maneuver, involving elevation of the head of the bed at 90? for 30 minutes, physicians can see if neurologic deficits recur, helping them determine the course of treatment. Raising the patient's head would theoretically put pressure on the collateral vessels, and if infarction is imminent, the patient's condition would worsen.

To test the theory, developed at the University of California Los Angeles Stroke Center (UCLA, USA), clinicians prospectively followed five patients who had acute middle cerebral artery occlusion and substantial deficits initially, but improved while recumbent during magnetic resonance imaging (MRI) scanning. Two of the patients showed no neurologic worsening when the bed head was raised, and were treated with supportive care with good final outcome. The other three patients' condition deteriorated, with recurrent hemiparesis, aphasia, and hemineglect within 30 minutes of having the head of their beds raised. These three patients underwent endovascular mechanical embolectomy with successful recanalization and excellent final outcome.

The results were reported by Dr. Latisha K. Ali of the UCLA stroke center at the American Academy of Neurology 58th Annual Meeting held during April 2006 in San Diego (CA, USA).



Related Links:
UCLA Stroke Center