Location-dependent patterns in cardio-autonomic dysfunction in ischaemic stroke.
OBJECTIVE
Autonomic nervous system dysfunction is a common complication of acute cerebrovascular disorders. The aim of this study was to investigate a possible location-dependent difference in cardio-autonomic function in patients with ischaemic stroke.


METHODS
Sympathetic function was prospectively assessed by determining plasma norepinephrine and epinephrine in 19 patients with left-hemisphere (LH), 14 with right-hemisphere (RH) and 6 with brainstem/cerebellar (BS) stroke. Blood pressure, heart rate, cardiac output and transcranial flow velocity in the middle cerebral artery were recorded during the first 5 days after stroke.


RESULTS
Stroke caused an initial increase in sympathetic function in all 3 groups with a spontaneous decrease in norepinephrine in LH (p < 0.01) and BS stroke (p < 0.05) only. Norepinephrine was significantly higher in RH than in BS stroke (p < 0.05). The alterations in autonomic function were paralleled by a sustained elevation in cardiovascular parameters mainly in RH stroke.


CONCLUSIONS
Plasma catecholamines are feasible in monitoring location-dependent autonomic dysfunction in ischaemic stroke. Hemispheric lateralization in autonomic control should be taken into account in the management of stroke because of an increased susceptibility to cardio-autonomic dysfunction in patients with RH stroke.
Strittmatter
M
M
Department of Neurology, SHG Kliniken Merzig, Merzig, Germany. m.strittmatter@mzg.shg-kliniken.de
Meyer
S
S
Fischer
C
C
Georg
T
T
Schmitz
B
B
D000368:Aged; D001342:Autonomic Nervous System Diseases / Q000175:diagnosis / Q000503:physiopathology*; D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D001921:Brain / Q000098:blood supply; D020526:Brain Stem Infarctions / Q000175:diagnosis / Q000503:physiopathology; D002302:Cardiac Output / Q000502:physiology; D002526:Cerebellar Diseases / Q000175:diagnosis / Q000503:physiopathology; D002544:Cerebral Infarction / Q000175:diagnosis / Q000503:physiopathology*; D038524:Diffusion Magnetic Resonance Imaging; D004292:Dominance, Cerebral / Q000502:physiology*; D004837:Epinephrine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000294:innervation*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000503:physiopathology; D008991:Monitoring, Physiologic; D009638:Norepinephrine / Q000097:blood; D011446:Prospective Studies; D013564:Sympathetic Nervous System / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed; D017585:Ultrasonography, Doppler, Transcranial
D009638:Norepinephrine; D004837:Epinephrine