Blood Pressure Management in Acute Ischemic Stroke With Concurrent Intracranial Neoplasm and Intratumoral Hemorrhage

Acute ischemic stroke is a major cause of morbidity and mortality worldwide. Furthermore, careful clinical assessment combined with neuroimaging is crucial for an accurate diagnosis and allows other differential diagnoses to be determined. We report a case of an 81-year-old female with a history of hypertension who presented with dysarthria, left central facial paresis, and right oculocephalic deviation. Cranial CT revealed no acute ischemic lesions, and no vessel occlusion was detected in CT angiography. Incidentally, an extra-axial left lateropontine space-occupying lesion with recent bleeding was detected. The patient remained under surveillance with permissive hypertension, without antithrombotic drugs. A clinical worsening with somnolence and left VI and VII nerve palsies followed, motivating cranial CT repetition, which disclosed aggravated bleeding of the space-occupying lesion and an acute right frontal ischemic lesion. Upon discussion with Neurosurgery, no surgery was offered, and the patient was admitted to the Stroke Unit, with strict blood pressure control and delay of antiplatelet initiation. At the time of discharge, the patient showed neurological improvement. Permissive blood pressure regimens in patients with acute ischemic stroke not reperfused are still not well studied when concurrent intracranial tumors exist, where the potential to aggravate/precipitate intratumoral hemorrhage exists. This case report highlights the need to better delineate the strategy regarding blood pressure control in these patients.