enalapril and Intracranial-Hypertension

Over 80% of patients exhibit an acute increase in blood pressure (BP) following stroke. Current clinical guidelines make no distinction in BP management between patients with or without prior hypertension. Spontaneously hypertensive (SH) rats were preinstrumented with telemeters to record BP, intracranial pressure, and brain tissue oxygen in the predicted ischemic penumbra for 3 days before and 10 days after transient middle cerebral artery occlusion (n=8 per group) or sham (n=5). Before stroke, BP was either left untreated or chronically treated to a normotensive level (enalapril 10 mg/kg per day). Poststroke elevations in BP were either left uncontrolled, controlled (to the prestroke baseline level), or overcontrolled (to a normotensive level) via subcutaneous infusion of labetalol. Baseline values of intracranial pressure and brain tissue oxygen were similar between all groups, whereas BP was lower in treated SH rats (144±3 versus 115±5 mm Hg;

Topics: Angiotensin-Converting Enzyme Inhibitors; Animals; Antihypertensive Agents; Blood Pressure; Brain; Brain Chemistry; Brain Ischemia; Enalapril; Hypertension; Infarction, Middle Cerebral Artery; Intracranial Hypertension; Male; Movement Disorders; Oxygen; Random Allocation; Rats; Rats, Inbred SHR; Recovery of Function; Time Factors

Posterior reversible encephalopathy syndrome (PRES) and cerebral sinus thrombosis are 2 known complications of acute lymphoblastic leukemia and its treatment. We describe a patient with acute lymphoblastic leukemia whose course was complicated by both of these conditions. This case is novel both for the fact that PRES developed before the initiation of therapy and that PRES was followed shortly by the development of cerebral sinus thrombosis. Our patient's story raises questions about our current understanding of the pathophysiology of PRES, and it suggests that PRES may actually be a predisposing risk factor for cerebral sinus thrombosis.

Topics: Antineoplastic Combined Chemotherapy Protocols; Brain Ischemia; Cerebral Infarction; Child, Preschool; Enalapril; Enoxaparin; Female; Humans; Intracranial Hypertension; Magnetic Resonance Imaging; Neuroimaging; Occipital Lobe; Papilledema; Parietal Lobe; Posterior Leukoencephalopathy Syndrome; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma; Remission Induction; Sinus Thrombosis, Intracranial