title: Lateralization in autonomic dysfunction in ischemic stroke involving the insular cortex.
abstract: Autonomic nervous system dysfunction is a common complication of ischemic stroke. Clinical and experimental data indicate hemispheric lateralization in the control of autonomic activity. The insular cortex has also been shown to play a crucial role in the central autonomic network. The aim of this study was to assess cardio-autonomic dysfunction in patients with ischemic insular versus non-insular cortex infarction, and to demonstrate a possible lateralization in autonomic activity mediated by the insular cortex. Sympathetic function was prospectively assessed by determining plasma norepinephrine and epinephrine in 15 patients with left-hemisphere (LH; four insular infarction), and 14 with right-hemisphere (RH) middle cerebral artery (MCA) stroke (five insular infarction). Systolic and diastolic blood pressure and heart rate were recorded during the first 5 days after stroke. Sympathetic activity was significantly higher in insular than in non-insular infarction (p < 0.05) with concomitantly elevated cardiovascular parameters in insular stroke patients. The pathological activation of the sympathetic nervous system was most excessive in RH-stroke involving the insular cortex (p < 0.05). Our data indicate a hemispheric lateralization in autonomic activity which is mediated by the right-sided insular cortex. Patients with RH stroke involving the insular cortex are most susceptible to develop cardio-autonomic dysfunction.
authors.affiliation: Department of Neurology and Pediatrics, University of the Saarland, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Meyer
authors.forename: M
authors.initials: M
authors.lastname: Strittmatter
authors.forename: C
authors.initials: C
authors.lastname: Fischer
authors.forename: T
authors.initials: T
authors.lastname: Georg
authors.forename: B
authors.initials: B
authors.lastname: Schmitz
mesh_terms: D000368:Aged; D001342:Autonomic Nervous System Diseases / Q000209:etiology / Q000473:pathology / Q000503:physiopathology*; D001794:Blood Pressure / Q000502:physiology; D002545:Brain Ischemia / Q000150:complications*; D015984:Causality; D002540:Cerebral Cortex / Q000473:pathology / Q000503:physiopathology*; D002544:Cerebral Infarction / Q000097:blood / Q000473:pathology / Q000503:physiopathology; D004837:Epinephrine / Q000097:blood; D007839:Functional Laterality / Q000502:physiology*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications; D008875:Middle Aged; D008771:Nordefrin / Q000097:blood; D011446:Prospective Studies; D020521:Stroke / Q000150:complications*
chemical_list: D008771:Nordefrin; D004837:Epinephrine