title: Prognostic relevance of pathological sympathetic activation after acute thromboembolic stroke.
abstract: OBJECTIVE
  To evaluate the prognostic impact of early pathologic sympathetic activation after stroke.
  
  
  METHODS
  The authors examined 112 consecutive patients (mean age, 69 years; 60 men) with their first brain infarction. A pathologic sympathetic activation was presumed if the initial norepinephrine level exceeds 300 pg/mL. In addition, involvement of the insular cortex, nighttime blood pressure changes, and several cardiovascular risk factors were determined. One-year outcome measures were mortality rate, cardiovascular and cerebrovascular events, and activities of daily living (Barthel index and Rankin score).
  
  
  RESULTS
  Norepinephrine levels greater than 300 pg/mL, nighttime blood pressure increases, and insular involvement were associated with a lower Barthel index (p < 0.005) at the 1-year follow-up. By stepwise logistic regression analysis, insular infarction, serum norepinephrine concentration, right-sided infarction, and nighttime blood pressure increase were significant and independent predictors of an unfavorable functional outcome. Cox regression analysis showed a higher rate of cardiovascular and cerebrovascular events (hazard ratio, 2.9; 95% CI, 1.07; 6.83; p < 0.04) in patients with initially increased norepinephrine concentrations.
  
  
  CONCLUSIONS
  The involvement of the insular cortex, the occurrence of a pathologic nighttime blood pressure increase, and an initially increased serum norepinephrine concentration are independent predictors of poor long-term outcome.
authors.affiliation: Department of Neurology, Technical University of Munich, Germany. Dirk.Sander@neuro.med.tu-muenchen.de
authors.forename: D
authors.initials: D
authors.lastname: Sander
authors.forename: K
authors.initials: K
authors.lastname: Winbeck
authors.forename: J
authors.initials: J
authors.lastname: Klingelhöfer
authors.forename: T
authors.initials: T
authors.lastname: Etgen
authors.forename: B
authors.initials: B
authors.lastname: Conrad
mesh_terms: D000368:Aged; D002544:Cerebral Infarction / Q000097:blood* / Q000150:complications; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000150:complications; D016015:Logistic Models; D008297:Male; D009638:Norepinephrine / Q000097:blood*; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D011446:Prospective Studies; D020521:Stroke / Q000097:blood* / Q000150:complications; D016019:Survival Analysis; D013564:Sympathetic Nervous System / Q000378:metabolism* / Q000473:pathology; D013923:Thromboembolism / Q000097:blood* / Q000150:complications
chemical_list: D009638:Norepinephrine