Insular Involvement Is Associated with QT Prolongation: ECG Abnormalities in Patients with Acute Stroke

Tatschl, C.; Stöllberger, Claudia; Matz, Karl; Yilmaz, Nilgün; Eckhardt, Raoul; Nowotny, Monika; Dachenhausen, Alexandra; Brainin, Michael

doi:10.1159/000089594

Cited by 59 publications

(45 citation statements)

References 29 publications

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“…Since this was noted only within 24 hours of stroke onset, it strengthens the association and interestingly, was noted specifically with insular infarcts [16]. Further insular association arises from the linkage between right insular stroke and AV block, QTc prolongation, T wave inversion and ventricular ectopy, (these not observed with strokes in other locations) and with increased mortality at 3 months [17,18].…”

Section: Strokesupporting

confidence: 60%

Cerebrogenic cardiopathy

Oppenheimer¹

2017

Blood Heart Circ

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Hypereosinophilic Syndrome (HES) is a condition related to helminthiasis, allergies, vasculitis, adverse reactions to drugs or malignant neoplasms. We report a case of a boy, 7 years old, presenting abdominal pain, vomiting, tachidispnea and leukocytosis with predominance of eosinophils. Bone marrow biopsy revealed intense granulocytic hypercellularity characterized by eosinophilia, as well as immature lymphoid cells in the interstitium, associated with trabecular bone infiltration. The immunohistochemical study revealed positivity for CD79a and TDT. Peripheral blood flow cytometry demonstrated 6.5% of lymphoid blasts. The diagnosis was Lymphoproliferative Disease associated with Hypereosinophilia: Acute Lymphoblastic Leukemia. The association presented is infrequent and its aggressiveness is determined by the physiological limitations imposed by the damages secondary to eosinophilia.

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Section: Strokesupporting

confidence: 60%

Cerebrogenic cardiopathy

Oppenheimer¹

2017

Blood Heart Circ

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“…Human studies have shown bradycardia and reduced blood pressure with stimulation of the left insular cortex, and the converse with stimulation of the right insula [12]. Insular damage has been associated with loss of central inhibitory control resulting in activation of the sympathetic nervous system, increased heart rate and blood pressure, impaired autonomic control of heart rate variability, QT prolongation [13], and, in particular, right insular damage has been associated with increased risk of cardiac arrhythmias [14,15,16,17]. …”

Section: Introductionmentioning

confidence: 99%

Elevated Troponin Levels Are Associated with Sympathoadrenal Activation in Acute Ischaemic Stroke

Barber

Morton²,

Macfarlane³

et al. 2006

Cerebrovasc Dis

136

120

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Background: It has been hypothesised that elevated serum troponin levels in acute stroke are due to myocardial damage caused by sympathoadrenal activation, which, in turn, may be due particularly to insular damage. We aimed to determine the factors associated with troponin elevation in ischaemic stroke and the prognostic value of this finding. Methods: We studied 222 consecutive acute ischaemic stroke admissions. Serum troponin I and catecholamines were measured. Ischaemic damage on brain computed tomography (CT) scan was graded using the Alberta Stroke Program Early CT Score (ASPECTS). Electrocardiograms were classified using the Minnesota Code and the European Society of Cardiology/American College of Cardiology criteria for acute myocardial infarction. The Rankin scale was recorded at 30 days. Results: Forty-five patients (20%) had troponin I >0.2 µg/l. These troponin-positive patients had higher epinephrine levels (median 0.27 vs. 0.17 nmol/l; p = 0.0002) and were more likely to have electrocardiograms coded as definite or possible acute myocardial infarction (odds ratio 3.35; 95% CI 1.26–8.93), compared with those with troponin ≤0.2 µg/l, in univariate analysis. There were no significant associations between troponin I score and ASPECTS or insular damage on brain CT. In logistic regression analyses, elevated troponin was significantly associated with age, elevated serum creatinine and epinephrine; however, increased troponin was not an independent predictor of death or dependency (Rankin >2) at 30 days. Conclusions: Raised troponin I is associated with elevation of circulating epinephrine in acute ischaemic stroke. Activation of the sympathoadrenal system may be an important contributor to myocardial damage in these patients. Increased troponin is not associated with insular damage and does not independently predict poor outcome.

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“…Stroke patients may present, as a cause or consequence, multiple organ dysfunctions, which justifies carrying out further tests. Some changes of cardiac function, particularly arrhythmias and acute myocardial infarction, are common after a stroke [56][57][58][59][60][61][62] . There is no evidence in favor of oxygen supplementation for all patients in the acute phase of stroke.…”

Section: Stroke In the Emergency Departmentmentioning

confidence: 99%

Guidelines for acute ischemic stroke treatment: part I

Oliveira‐Filho

Martins

Pontes-Neto

et al. 2012

Arq. Neuro-Psiquiatr.

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These guidelines are a result of several meetings from the Brazilian Stroke Society (Sociedade Brasileira de Doenças Cerebrovasculares -SBDCV, website www.sbdcv.org.br), which represents the Scientific Department in cerebrovascular diseases of the Brazilian Academy of Neurology, responsible for technical opinions and educational projects related to cerebrovascular diseases. Members from SBDCV participated in web-based discussion forum with pre-defined themes, followed by a formal onsite meeting in which controversies and final position statements were discussed. Finally, a writing group was created to revise and translate the final document, which was approved by all members of the SBDCV. The final text aims to guide specialists and non-specialists in stroke care in managing patients with acute ischemic stroke. The hemorrhagic stroke guideline has been previously published by the same group 1 . In the final recommendations, Oxford classification for evidence level and recommendation grade was used: EVIDENCE LEVELS1. Randomized controlled clinical trial (RCT) or systematic review (SR) of RCT with clinical endpoints. 2. RCT or SR of lower quality: with substitute, validated endpoints; with subgroup analysis or with a posteriori hypotheses; with clinical endpoints, but with methodological flaws.3. RCT with substitute, non-validated endpoints case-control studies. 4. Study with clinical endpoint, but with a higher potential bias (as in experiment without comparison group and other observational studies). 5. Representative forum or expert opinion without abovementioned evidence. RECOMMENDATION GRADESA Systematic review (homogeneous) of RCT; or single RCT with narrow confidence interval; or therapeutic results of "all or nothing" type. B Systematic review (homogeneous) of cohort studies; or cohort study and RCT of lower quality; or outcomes research or ecological study; or systematic review (homogeneous) of case-control studies; or case-control study. C Case reports (including cohort or case-control study of lower quality). D Expert opinion without critical evaluation, based on physiological or animal studies.In this first part of the guidelines, specific topics included were: epidemiology, stroke as a medical emergency, education, pre-hospital management, emergency management, neuroimaging and laboratory evaluation. A translated version of these guidelines in Portuguese is available in the Society's webpage (www.sbdcv.org.br).

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Insular Involvement Is Associated with QT Prolongation: ECG Abnormalities in Patients with Acute Stroke

Cited by 59 publications

References 29 publications

Cerebrogenic cardiopathy

Cerebrogenic cardiopathy

Elevated Troponin Levels Are Associated with Sympathoadrenal Activation in Acute Ischaemic Stroke

Guidelines for acute ischemic stroke treatment: part I

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