title: Nocturnal deterioration after ischemic stroke and autonomic dysfunction: hypothesis and implications.
abstract: BACKGROUND
  A significant number of patients admitted to hospital after acute ischemic stroke deteriorate clinically. Deterioration is generally noted within the first 48 h after stroke onset. The mechanisms leading to this deterioration are not fully understood.
  
  
  CONCLUSIONS
  One potential cause of this deterioration may be altered or impaired autonomic function. We expect the hemodynamic changes regulated by the autonomic nervous system that are dysregulated after stroke to be exaggerated during sleep, resulting in arrhythmia and blood pressure fluctuations in these patients. Such physiological changes could result in worsening the overall outcome of the ischemic stroke patient or in sudden death. Therefore, it is necessary to summarize yet unrelated observations and hypothesize on their individual effects and interactions as they relate to poststroke deterioration.
  
  
  CONCLUSIONS
  If the hypothesis is correct that dysautonomia occurs to the degree that it affects clinical outcomes negatively, this would have important implications for the prevention of neurological deterioration and sudden death after ischemic stroke.
authors.affiliation: Department of Clinical Neurological Sciences, University Hospital, London Health Sciences Centre, London, Ont., Canada.
authors.forename: Iryna
authors.initials: I
authors.lastname: Palamarchuk
authors.forename: Kurt
authors.initials: K
authors.lastname: Kimpinski
authors.forename: Corbin
authors.initials: C
authors.lastname: Lippert
authors.forename: Vladimir
authors.initials: V
authors.lastname: Hachinski
mesh_terms: D002545:Brain Ischemia / Q000150:complications*; D003645:Death, Sudden / Q000517:prevention & control*; D006801:Humans; D054969:Primary Dysautonomias / Q000209:etiology*; D012890:Sleep / Q000502:physiology*; D020521:Stroke / Q000150:complications*; D013997:Time Factors