Journal of Neurology

, Volume 266, Issue 4, pp 990–997 | Cite as

Early microvascular cerebral blood flow response to head-of-bed elevation is related to outcome in acute ischemic stroke

  • Clara Gregori-PlaEmail author
  • Igor Blanco
  • Pol Camps-Renom
  • Peyman Zirak
  • Isabel Serra
  • Gianluca Cotta
  • Federica Maruccia
  • Luís Prats-Sánchez
  • Alejandro Martínez-Domeño
  • David R. Busch
  • Giacomo Giacalone
  • Joan Martí-Fàbregas
  • Turgut Durduran
  • Raquel Delgado-Mederos
Original Communication


Background and aims

Previously, microvascular cerebral blood flow (CBF) response to a mild head-of-bed (HOB) elevation has been shown to be altered in acute ischemic stroke (AIS) by diffuse correlation spectroscopy (DCS). We have hypothesized that early CBF response is related to the functional outcome.


Patients with a non-lacunar AIS in the anterior circulation were monitored by DCS to measure relative CBF (ΔrCBF) on the frontal lobes bilaterally during a 0°–30° HOB elevation at early (≤ 12) or late (> 12) hours from symptom onset. National Institutes of Health Stroke Scale (NIHSS) scores were recorded at baseline at 24 and at 48 h. Functional outcome was measured by the modified Rankin Scale (mRS) at 3 months.


Thirty-eight (n = 38) AIS patients [baseline NIHSS = 19 (interquartile range: 16, 21)] were studied. ΔrCBF decreased similarly in both hemispheres (p = 0.4) when HOB was elevated and was not associated with baseline and follow-up NIHSS scores or patient demographics. At the early phase (n = 17), a lower or paradoxical ΔrCBF response to HOB elevation was associated with an unfavorable functional outcome (mRS > 2) in the ipsilesional (but not in the contralesional) hemisphere (p = 0.010). ΔrCBF response in the late acute phase was not related to mRS.


Early CBF response to mild HOB elevation in the ipsilesional hemisphere is related to functional outcome. Further studies may enable optical monitoring at the bedside to individualize management strategies in the early phase of AIS.


Ischemic stroke Outcome Cerebral blood flow Brain perfusion Diffuse correlation spectroscopy Near-infrared spectroscopy 



This work was funded by Redes Temáticas de Investigación Cooperativa (RETICS-INVICTUS RD012/0014, RD16/0019/0010), Fundació CELLEX Barcelona, Ministerio de Economía y Competitividad/FEDER (PHOTODEMENTIA, DPI2015-64358-C2-1-R), ISCIII/FEDER (MEDPHOTAGE, DTS16/00087, FIS-PI09/0557, FIS2015-71851-P), “Severo Ochoa” Programme (SEV-2015-0522), Obra Social “la Caixa” (LlumMedBcn, Recerca Matemàtica Col·laborativa), Institució Centres de Recerca de Catalunya, Agència de Gestió d’Ajuts Universitaris i de Recerca (2017SGR-1380, 2014SGR-1307), LASERLAB-EUROPE IV (EU-H2020-654148), Whitaker International, T32 HL007954 Multidisciplinary training in cardiovascular biology, “Fundació La Marató TV3” (201709.31) and Marie Curie Initial Training Network (OILTEBIA/317526).

Compliance with standards

Conflicts of interest

ICFO has equity ownership in HemoPhotonics S.L. commercializing relevant technologies. Potential financial conflicts of interest and objectivity of research have been monitored by ICFO Knowledge & Technology Transfer Department and none were identified.

Ethical standard

All human studies have been approved by the appropriate ethics committee (EC/15/130) and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Supplementary material

415_2019_9226_MOESM1_ESM.pdf (148 kb)
Supplementary material 1 (PDF 148 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Clara Gregori-Pla
    • 1
    Email author
  • Igor Blanco
    • 1
  • Pol Camps-Renom
    • 2
  • Peyman Zirak
    • 1
  • Isabel Serra
    • 3
  • Gianluca Cotta
    • 1
  • Federica Maruccia
    • 1
    • 4
  • Luís Prats-Sánchez
    • 2
  • Alejandro Martínez-Domeño
    • 2
  • David R. Busch
    • 5
  • Giacomo Giacalone
    • 1
    • 6
  • Joan Martí-Fàbregas
    • 2
  • Turgut Durduran
    • 1
    • 7
  • Raquel Delgado-Mederos
    • 2
  1. 1.ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and TechnologyCastelldefelsSpain
  2. 2.Department of NeurologySant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant PauBarcelonaSpain
  3. 3.Centre de Recerca Matemàtica (CRM)BellaterraSpain
  4. 4.Neurotraumatology and Neurosurgery Research UnitVall d’Hebron University Research InstituteBarcelonaSpain
  5. 5.Departments of Anesthesiology and Pain Management; Neurology and NeurotherapeuticsUniversity of Texas Southwestern Medical CenterDallasUSA
  6. 6.San Raffaele Scientific InstituteMilanItaly
  7. 7.Institució Catalana de Recerca i Estudis Avançats (ICREA)BarcelonaSpain

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