[Unfavorable outcome of aggressive lowering of high blood pressure. Case report]

Cerebral autoregulation is essential in the maintenance of cerebral blood flow. Due to this autoregulation, cerebral perfusion is constant in healthy subjects if blood pressure values are between 50-150 mmHg. In hypertensive patients the curve is right-shifted towards higher blood pressure values (pathological autoregulation). Aggressive blood pressure reduction can lead to severe ischaemia. The authors report the history of a 73-year-old man with the background history of widespread atherosclerotic disease. The patient complained about headache and dizziness and was found to have high blood pressure (160/100 mmHg) and increased blood glucose (14.8 mmol/l). Prior to his admission an aggressive blood pressure and blood sugar reduction was carried out and, within a short period of time he became unconscious and was transferred to the department of the authors with the possible diagnosis of brainstem stroke. On admission the patient was unresponsive, comatose with brainstem symptoms. Urgent brain computed tomography failed to show any acute alterations. However, repeat CT scan revealed extensive bilateral space occupying ischemic changes involving in territories of both internal carotid arteries with consequent brainstem compression. Computed tomography angiography confirmed bilateral internal carotid artery occlusion. The authors conclude that intensive blood pressure reduction result in ischemic lesions via hypoperfusion especially in patients with widespread atherosclerotic disease and significant carotid vessel pathology.