Transient autonomic nervous system dysfunction during hyperacute stroke

Abstract

Forty-four patients suffering a stroke for the first time were examined within 10 h of the onset of symptoms; the tests performed on their admission to hospital, and thereafter on the third and seventh day, were 24-h Holter EKG with spectral analysis of heart rate variability, evaluation of arterial blood pressure and the levels of catecholamine in the blood and 24-h urine. The dynamic EKG on admission revealed that 31 (70.5%) out of the 44 patients already had arrhythmia. These alterations were observed in 9 (75%) out of 12 haemorrhagic patients with a significant (P < 0.05) prevalence compared to 22 (68.8%) of the 32 ischaemic ones. Arrhythmia showed up in 16 (76.2%) out of 21 cases with right hemisphere lesions and in 12 (63.2%) out of 19 cases of left hemisphere lesions; this difference was also significant (P<0.05). Arrhythmia was still present in 19 (43.2%) patients after 3 days and only in 2 (6.5%) patients after 7 days. The spectral analysis parameters on admission and after 3 days were significantly (P < 0.05) modified in patients with stroke plus arrhythmia, compared to patients with stroke alone and to control subjects, whereas no further differences were observed on the seventh day. Moreover, the percentage of patients with arterial hypertension and high levels of catecholamine greatly decreased from the third day onwards. A transient autonomic nervous system imbalance with prevalent sympathetic activity may justify this cardiovascular impairment during the hyperacute phase of stroke.

Prognostic Implications of Right-Sided Insular Damage, Cardiac Autonomic Derangement, and Arrhythmias After Acute Ischemic Stroke

“…[1][2][3][4] Abnormalities of cardiovascular autonomic control may also retain prognostic relevance, as reduced heart rate variability (HRV) and impaired cardiac baroreceptor sensitivity have both been associated with adverse clinical outcome after stroke. [5][6] Furthermore, all stroke-related autonomic abnormalities appear more relevant in patients with right-sided hemispheric infarctions, [7][8][9][10] with concurrent involvement of the right insula implying further derangement of cardiovascular function 10 -13 and even an increase of the odds of death within 3 months of acute stroke. 14 However, to date, the relative prognostic significance in stroke patients of right-sided insular involvement in the infarct area, as well as that of cardiac autonomic impairment and arrhythmias, has not been fully clarified.…”

Electrocardiographic Changes and Their Prognostic Effect in Patients with Acute Ischemic Stroke without Cardiac Etiology

“…In some studies there is an uncertainty if these changes are secondary to stroke, it is thought that stroke may affect cardiac rhythm directly or indirectly (20). It was reported that the incidence of ECG abnormality after acute ischemic stroke is between 45% and 90%.…”

Asymmetric Insular Function Predicts Positional Blood Pressure in Nondemented Elderly

“…{1} This is predicated on our observation of a specific association between visuospatial cognitive measures and mortality in non-demented elderly retirees. {2} Similar tests are known predict mortality in AD {3}, while right (R) hemisphere lesions are known to increase the risk of arrhythmic morbidity and mortality in stroke {4}, head injury {5} and epilepsy {6}. Strokes that affect constructional tasks often involve the R insula as well {7}.…”