Department of Neurology, Chungbuk National University College of Medicine, Cheongju, Korea
ABSTRACT
Intravascular volume and pressure reflect hemodynamic status and are tightly correlated. Changes in volume and pressure must be interpreted in light of the underlying neurologic disorder. In this review, we will suggest how to govern volume status and blood pressure and make several arguments for very cautious use of antihypertensive medications in the acute phase. Hypovolemia is a potential clinical concern in patient with acute central nervous system injury. A key assumption must be that most patient with an acute intracranial injury tend to have a certain degree of dehydration. Once common orders for fluid restriction in patients with acute catastrophic events have now been modified into skillful limitation of free water or at least maintenance of euvolemic fluid status or modest hypervolemia. The regimen for maintenance of fluid intake is based on an estimation of fluid loses and must be carefully monitored by laboratory findings. Increase in blood pressure is common in acute central nervous system lesions. The weight assigned to the risks and benefits of blood pressure treatment in acute phase varies widely. Careful titration of antihypertensive drugs has become a standard approach in the immediate aftermath of acute neurologic disorders. Treatment is indicated in patients with persistent extreme surges in blood pressure, rapidly progressing brain edema or impending congestive heart failure.
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