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Title: Cerebral haemodynamics with head position changes post-ischaemic stroke: A systematic review and meta-analysis.
Austin Authors: Carvalho, Lilian B;Kramer, Sharon F ;Borschmann, Karen ;Chambers, Brian R ;Thijs, Vincent N ;Bernhardt, Julie
Affiliation: St Vincent's Hospital, Melbourne, Australia
Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
Department of Medicine, University of Melbourne, Victoria, Australia
The Florey Institute of Neuroscience and Mental Health
NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, Australia
Issue Date: 13-May-2020
Date: 2020
Publication information: Journal of Cerebral Blood Flow and Metabolism 2020; online first: 13 May
Abstract: The effects of upright postures on the cerebral circulation early post-ischaemic stroke are not fully understood. We conducted a systematic review and meta-analysis to investigate the effects of head positioning on cerebral haemodynamics assessed by imaging methods post-ischaemic stroke. Of the 21 studies included (n = 529), 15 used transcranial Doppler. Others used near-infrared, diffuse correlation spectroscopy and nuclear medicine modalities. Most tested head positions between 0° and 45°. Seventeen studies reported changes in CBF parameters (increase at lying-flat or decrease at more upright) in the ischaemic hemisphere with position change. However, great variability was found and risk of bias was high in many studies. Pooled data of two studies ≤24 h (n = 28) showed a mean increase in cerebral blood flow (CBF) velocity of 8.5 cm/s in the ischaemic middle cerebral artery (95%CI,-2.2-19.3) from 30° to 0°. The increase found ≤48 h (n = 50) was of 2.3 cm/s (95%CI,-4.6-9.2), while ≤7 days (n = 38) was of 8.4 cm/s (95%CI, 1.8-15). Few very early studies (≤2 days) tested head positions greater than 30° and were unable to provide information about the response of acute stroke patients to upright postures (sitting, standing). These postures are part of current clinical practice and knowledge on their effects on cerebral haemodynamics is required.
DOI: 10.1177/0271678X20922457
ORCID: 0000-0003-2795-6259
Journal: Journal of Cerebral Blood Flow and Metabolism
PubMed URL: 32404023
Type: Journal Article
Subjects: Ischaemic Stroke
cerebral blood flow
cerebral haemodynamics
head position
upright position
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