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Urgent intervention to reduce functional deficits after postoperative stroke

Nature Clinical Practice Neurology volume 3, pages 173–177 (2007)Cite this article

Abstract

Background A 67-year-old right-handed man with a history of atrial fibrillation developed sudden aphasia after urological surgery. Initial diffusion-weighted and perfusion-weighted MRI demonstrated an area of hypoperfusion in Broca's area, with minimal infarction.

Investigations Neurological examination, language testing and brain MRI scans with diffusion-weighted and perfusion-weighted imaging.

Diagnosis Acute cardioembolic stroke with minimal infarction in Broca's area and a surrounding region of potentially salvageable, hypoperfused cortex.

Management Saline-induced hypertension resulting in rapid restoration of cortical perfusion and a resolution of the initial speech and language deficits. The utility of perfusion-weighted imaging in selecting appropriate candidates for urgent treatment of stroke when thrombolysis is contraindicated is discussed.

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Figure 1: Improvement of the patient's performance to a normal level on four language tests after induced hypertension treatment to restore blood flow
Figure 2: Diffusion-weighted and perfusion-weighted images of the patient (A) before and (B) after intervention with induced hypertension

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Acknowledgements

The research reported in this paper was supported by the National Institutes of Health (National Institute on Deafness and Other Communication Disorders) through RO1 DC 05375 and by NCRR P41 RR15241. We gratefully acknowledge this support and the participation of the patient.

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Authors and Affiliations

  1. AW Lee is a Postdoctoral Fellow in Cerebrovascular Neurology, C Davis is a Research Assistant in Neurology, HA Puttgen is Chief Resident in Neurology, and AE Hillis is a Professor of Neurology with joint appointments in Physical Medicine and Rehabilitation and in Cognitive Science, at Johns Hopkins School of Medicine, Baltimore, MD, USA.,

    Andrew W Lee, Cameron Davis, H Adrian Puttgen & Argye E Hillis

Authors
  1. Andrew W Lee
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  2. Cameron Davis
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  3. H Adrian Puttgen
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  4. Argye E Hillis
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Correspondence to Andrew W Lee or Argye E Hillis.

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The authors declare no competing financial interests.

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Lee, A., Davis, C., Puttgen, H. et al. Urgent intervention to reduce functional deficits after postoperative stroke. Nat Rev Neurol 3, 173–177 (2007). https://doi.org/10.1038/ncpneuro0422

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