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Twenty-nine patients(9.6%)had documented or presumed hypotension at stroke onset,with 27 of 29(93%)having watershed infarction on computed tomography (CT).Most(21/29)patients had a slow(hours to days)progressive onset to stroke.Myocardial infarction,cardiac arrhythmias,and orthostatis changes in blood pressure related to diabetic dysautonomia and antihypertensive therapy were the predominant causes of hypotension.Ten patients had moderate or severe carotid stenosis(frequently bilateral);9 had carotid occlusion(19/29[66%]).Patients with normal carotid arteries(10/29[34%])has hypotension with a stuttering onset to stroke and watershed infarction on CT.Many patients continued to have progressive neurological deterioration, often with ongoing hemodynamic instability.Three of 7 patients who underwent carotid endarterectomy had further perioperative ischemic events.Five patients had myocardial infarction,and overall 4 died during 18.4 months of follow-up(mortality,9%/y).Recognition of the clinical and CT features of hemodynamic stroke allows early identification and management of cardiac and carotid disease with correction of iatrogenic causes of hypotension,which may reduce the risk of further events. |
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arrhythmia,cardiac
border zone hypoperfusion
border zone infarct
carotid artery disease
carotid artery occlusion,neck
carotid artery stenosis
carotid artery stenosis,bilateral
CAT scan
CAT scan,abnormal
cerebral hypoperfusion
cerebral ischemia
endarterectomy,carotid
hypotension,systemic
limb shaking
myocardial infarction
prognosis
syncope
syncope,recurrent
watershed infarcts
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