Stump pain is caused by many conditions. Although chronic expanding hematoma is a rare condition, it should be considered as a possible cause of stump pain.
lood pressure (BP) and heart rate (HR) often fluctuate extensively in stroke patients during the acute to subacute phase. 1 In addition, cerebral blood flow is dependent on systemic BP during these phases because of the disturbance of autoregulation of cerebral blood flow. 2 Therefore it is important to consider the risk of stroke relapse or progression caused by fluctuating BP, such as an increase or decrease of BP and BP variability (BPV). 3,4 Some clinical studies have shown that an abnormal pattern of variability of diurnal BP, evaluated by 24-h ambulatory BP monitoring, 5 is associated with target organ damage. 6 Currently, the Holter ECG is used to monitor spontaneous heart rate variability (HRV) to assess the function of the cardiac autonomic nervous system in stroke patients. [7][8][9][10][11] Singh et al reported that autonomic nervous system activity, monitored by HRV, was related to 24-h BPV. 12 Clinical and experimental studies have examined how the localization of stroke affects autonomic function and prognosis. [13][14][15] Stroke patients with a lesion in the thalamus or brain stem often show high BP and other cardiovascular dysfunction. We assumed that stroke patients with a thalamic lesion would exhibit autonomic nervous dysfunction.The purpose of this study was to clarify the autonomic nervous system dysfunction and evaluate the risk during medical rehabilitation in stroke patients with a thalamic Circulation Journal Vol.69, June 2005 lesion, using 24-h HRV and 24-h BPV. The relationship between HRV, as well as 24-h BPV, and the change in BP during exercise was also investigated. Methods SubjectsThe subjects were patients who were admitted to the Stroke Medical Center within 2 weeks of the onset of their first stroke. The stroke group (Table 1) Relation Between 24-h Heart Rate Variability and Blood Pressure Fluctuation During Exercise in Stroke PatientsYasuko Nishioka, MD; Hironobu Sashika, MD*; Norihiko Andho, MD*; Osamu Tochikubo, MD** Background In some stroke patients blood pressure (BP) fluctuates extensively during medical rehabilitation, so the present study investigated the influence of autonomic nervous dysfunction on the change in BP during exercise. Methods and ResultsThe subjects consisted of 55 stroke inpatients (males, 29; mean age, 58.8 years old; ischemic/hemorrhagic etiology, 30/25) who were admitted to the Stroke Center within 2 weeks of their first stroke. The control group consisted of 15 age-matched healthy volunteers. The 24-h heart rate (HR) variability (HRV) and BP variability (BPV) were examined, and then the increase and recovery of BP and HR were measured during bicycle ergometer exercise at 4 METs. Components of 24-h HRV (low-frequency power (LF), highfrequency power (HF), LF/HF, and asleep -awake ratio of LF/HF (LF/HFd-n)) were lower (p<0.01) and BPV was greater in the stroke group (p<0.05) than in the control group. There was a negative correlation between BP change during exercise and LF/HF or LF/HFd-n (r=-0.43 or r=-0.58, p<0.01), and a greater increase in sy...
Cerebral autoregulation is mediated by blood pressure and the resistance of arteries, which are under the control of the autonomic nervous system. We examined the heart rate variability (HRV of stroke patients to clarify the impairment of both autonomic nervous activity and blood pressure variability (BPV), in relation to the degree of arteriosclerosis of the carotid artery (plaque score). We studied three parts. There are as follows: Study 1 is relationship between HRV and localization of stroke. The subjects consisted of 68 stroke patients (50 men and 18 women). The average age was 61.4+10.6 years. About one month after their strokes, we analyzed HRV by a 24-hour ECG (Holter recording. Study 2 is the relation of HRV and BPV and the degreee of arterioscerosis. The subjects consisted of 40 thalamic stroke patients (22 men and 18 women). The average age was 60.9+9.6 years. The degree of arteriosclerosis was evaluated using plaque score by ultrasonography of the carotid artery. We applied a portable automatic BP recorder over 24-hour periods to study BPV after one month from the onset of stroke. The sympathetic variable of the frequency domain of HRV was analyzed in relation to BPV and the degree of arteriosclerosis. Study 3 is consecutive change of HRV. A 24-hour ECG recording for 40 patients was implemented consecutively at 1 week, 1 month, and 3 month after the onset of stroke. The control subjects were 12 age-matched healthy adult volunteers. The essential components of HRV were significantly lower in stroke patients with lesions in the thalamus and brainstem. The sympathetic variable of the frequency domain of HRV (LF/ HF was significantly correlated with short-term BPV and the degree of arteriosclerosis. HRV was lower during the acute phase, and continued to be low through to the chronic phase. The autonomic nervous function in stroke patients, especially with thalamic lesion, was reduced. This might cause the fluctuation of blood pressure associated with the reduction of the baroreceptor response caused by arterio sclerosis. It is therefore suggested that HRV is a useful measure for predicting the unstable blood pressure of stroke patients.
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