Autonomic dysfunction after mild acute ischemic stroke and six months after: a prospective observational cohort study

Abstract

Introduction Autonomic dysfunction is prevalent in ischemic stroke patients and associated with a worse clinical outcome. We aimed to evaluate autonomic dysfunction over time and the tolerability of the head-up tilt table test in an acute stroke setting to optimize patient care. Patients and method In a prospective observational cohort study, patients were consecutively recruited from an acute stroke unit. The patients underwent heart rate and blood pressure analysis during the Valsalva maneuver, deep breathing, active standing, and head-up tilt table test if active standing was tolerated. In addition, heart rate variability and catecholamines were measured. All tests were performed within seven days after index ischemic stroke and repeated at six months follow-up. Results The cohort was comprised of 91 acute stroke patients, mean (SD) age 66 (11) years, median (IQR) initial National Institute of Health Stroke Scale 2 (1–4) and modified Ranking Scale 2 (1–3). The head-up tilt table test revealed 7 patients (10%) with orthostatic hypotension. The examination was terminated before it was completed in 15%, but none developed neurological symptoms. In the acute state the prevalence of autonomic dysfunction varied between 10–100% depending on the test. No changes were found in presence and severity of autonomic dysfunction over time. Conclusion In this cohort study of patients with mild stroke, autonomic dysfunction was highly prevalent and persisted six months after index stroke. Head-up tilt table test may be used in patients who tolerate active standing. Autonomic dysfunction should be recognized and handled in the early phase after stroke.

Stroke–heart syndrome: current progress and future outlook

“…Autonomic dysfunction, persisting for 6 months after stroke, plays a crucial role in SHS development [115]. Therefore, it is necessary to assess post-stroke cardiac dysautonomia.…”

Autonomic nervous system imbalance during aging contributes to impair endogenous anti-inflammaging strategies

“…Irrespective of the subtype of the ischemia, post-acute stroke patients are characterized by PNS cardiac deficit [ 66 , 67 ]. Notably, ischemic stroke is one of the most common causes of death and disability worldwide, and autonomic dysfunction has been observed in 25–76% of patients with acute stroke [ 68 ]. Neuroinflammation represents a major pathological event involved in the process of ischemic injury and repair, where microglia, the only macrophage population in the CNS parenchyma, plays key role in neuroinflammation.…”

The Effects of Autonomic Dysfunction on Functional Outcomes in Patients with Acute Stroke

“…In a prospective observational cohort study, autonomic dysfunction was highly prevalent in patients with mild acute ischemic stroke and persisted for 6 months. The prevalence of autonomic dysfunction in patients with mild acute stroke with a NIHSS score of 1-4 can range from 94 to 100%, depending on the type of autonomic function test [4,5].…”

“…Autonomic dysfunction is a common complication of acute stroke, which impairs functional outcomes, increases mortality [4], and occurs in approximately 25-76% of patients with acute stroke [5]. Autonomic dysfunction due to stroke affects respiratory, gastrointestinal, sudomotor, and urogenital functions through the dysregulation of the sympathetic and parasympathetic nervous systems [6,7].…”

“…Other studies have highlighted the importance of autonomic dysfunction. In a prospective observational cohort study, autonomic dysfunction was reported as highly prevalent in patients with mild acute ischemic stroke and persisted for 6 months [5]. Therefore, autonomic dysfunction is a major concern in patients with stroke.…”