Currently submitted to: JMIR Preprints
Date Submitted: Mar 7, 2026
Open Peer Review Period: Mar 7, 2026 - Feb 20, 2027
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Mechanical Volume Management in Acute Stroke: A First-Principles Biophysical Derivation
ABSTRACT
Background:
Current acute stroke management guidelines focus primarily on time-based imaging windows and the pharmacological suppression of acute hypertension. This paper proposes an alternative paradigm based on a first-principles theoretical derivation of hydraulic states.
Objective:
The primary goal of this framework is to establish the physiological feasibility of a "Stability Corridor" for Cerebral Perfusion Pressure (CPP) to maximize neuronal salvage.
Methods:
The methodology utilizes a first-principles biophysical derivation incorporating the Monro-Kellie Doctrine and Laplace's Law. It modifies the Cushing Reflex sequence, framing the terminal rise in intracranial pressure (ICP) as a result of a systemic blood pressure spike driven by ischaemic vasoparalysis.
Results:
The derivation identifies two phases of hydraulic failure: a "Masked Influx" where the 0.05 alpha extracellular space (ECS) buffer is exhausted, followed by a "Terminal Spike" in ICP. It establishes a "Stability Corridor" by identifying the Ischaemic Floor for collateral flow and the Elastic Limit to prevent vascular tearing.
Conclusions:
By modulating ICP to keep CPP within the Stability Corridor and using GFAP biomarkers as proxies for hydraulic integrity, clinicians can theoretically maintain cerebral perfusion and prevent the "Hydraulic Breach" of macro-haemorrhage. Clinical Trial: N/A (Theoretical Paper)
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