Clinical Study
Can Transient Drop in Blood Pressure in High-Risk Hypertensive Patients Cause Small Cerebral Infarcts?
Table 1
Features of all 78 patients with multiple, acute cerebral infarcts in different arterial territories.
| | No obvious cause
on initial evaluation | Cardiac | Border zone infracts | Hematological | value | | Group 1 | Group 2 | Group 3 |
| | Number of patients | 41 (52.6%) | 15 (19.2%) | 18 (23.1%) | 4 (5.1%) | | | Average age (years) | | | | | <0.0001 | | Age range | 43–92 | 53–86 | 47–85 | 26–55 | | | Male | 23 | 6 | 10 | 2 | NS | | Female | 18 | 9 | 8 | 2 | NS | | Diabetes | 20 (48.7%) | 4 (26.6%) | 6 (33.3%) | 1 (25%) | NS | | Hypertension | 38 (92.6%) | 12 (80%) | 16 (88.8%) | 1 (25%) | NS | | Cranial and cervical MR angiography (MRA) done | 36 (87.8%) | 13 (86.6%) | 17 (94.4%) | 3 (75%) | |
| | Echocardiogram done: | 35 (85.3%) | 15 (100%) | 15 (83.3%) | 3 (75%) | | | TTE | 24 | 8 | 12 | 1 | | | TEE | 11 | 7 | 3 | 2 | | | Cardiac abnormalities: | | | | | | | Atrial fibrillation | 0 | 8 | 0 | 0 | | | Acute MI | 0 | 2 | 0 | 0 | | | PFO/ASA | 0 | 1 | 0 | 0 | | | Endocarditis | 0 | 3 | 0 | 0 | | | Aortic dissection | 0 | 1 | 0 | 0 | | | Location of infarcts: | | | | | | | (i) Carotid circulation of both hemispheres | 17 (41.5%) | 4 (26.7%) | | 1 (25%) | NS | | (ii) One carotid circulation and vertebrobasilar circulation | 5 (12.2%) | 5 (33.3%) | | 1 (25%) | | | (iii) Both carotid circulations and vertebrobasilar circulations | 19 (46.3%) | 6 (40%) | | 2 (50%) | | | Location of infarcts: | | | | | | | Deep only | 22 (53.6%) | 0 | 9 (50%) | 1 (25%) | <0.0001 | | Deep + cortical | 16 (39%) | 11 (73.3%) | 9 (50%) | 1 (25%) | | | Cortical only | 3 (7.3%) | 4 (26.6%) | 0 | 2 (50%) | | | MRA findings: | | | | | | | (i) Cervical carotid stenosis/occlusion | 0 | 0 | 9 (50%) | 0 | <0.0001 | | (ii) Intracranial stenosis (>50%) | 16 (39%) | 9 (60%) | 9 (50%) | 0 | | | (iii) Minor irregularities/no stenoses | 20 (48.8%) | 4 (26.6%) | 0 | 3 (75%) | | | | 4 mm to 2.5 cm | 0.5 to 5 cm | Multiple | 2–8 cm | <0.0001 | | Size of infarcts | <2 cms: 39 | <2 cms: 6 | small | | | | | >2 cms: 2 | >2 cms: 9 | (0.5–1 cm) | | | | Number of infarcts | 2-3: 32 patients | 2-3: 6 patients | | 2-3: 3 patients | NS | | 4–8: 9 patients | 4–6: 9 patients | | 4: 1 patient | | Number of patients with chronic small vessel disease seen on MRI FLAIR images | 38 (92.6%) | 14 (93.3%) | 18 (100%) | 0 | <0.0001 | Mean arterial pressure (MAP)
(mm Hg) | | | | | | | At presentation: | | | | | NS | | Number of patients with low or normal BP at presentation | 16 of 41 patients had low or normal BP | 1 of 15 patients had normal BP
| 5 of 18 patients had low or normal BP | 2 of 4 patients had low or normal BP | | | | Subset of 13 patients with pre- and poststroke BP readings available: | | | | | Prestroke (<11 days):
At presentation
Poststroke (2 weeks): | 113.6 ± 11.3
82.9 ± 13.7
128.2 ± 14.3 | | | | | | | Remaining 25 patients with high BP: | | | | | | At presentation | | | | | |
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NS: not significant. Hematological causes found: protein S deficiency, lupus-associated coagulopathy, thrombotic thrombocytopenic purpura. Borderzone infarcts were assessed on typical topographic pattern [5, 6] (Figure 1(f)). PFO: patent foramen ovale, ASA: atrial septal aneurysm,
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