Effects of Stroke Localization on Cardiac Autonomic Balance and Sudden Death

Abstract

Background and Purpose-Stroke has been shown to alter autonomic function. The purpose of this study was to show the differential effects of stroke localization on autonomic function parameters assessed by heart rate variability (HRV). Methods-To determine the differential effect of ischemic stroke localization on autonomic cardiac innervation, we evaluated 62 patients with ischemic stroke and 62 age-and sex-matched controls. The localization of the infarct was determined by CT and MRI. Power spectrum analysis of HRV was performed. Myocardial necrosis was ruled out by echocardiography and creatine kinase myocardial isoenzymes measurements. Results-All stroke patients had significantly decreased low frequency, high frequency, and standard deviation of all relative risk intervals values (PϽ0.001). However, patients with right-middle cerebral artery (R-MCA) and insula lesions had significantly lower power spectrum analysis values compared with all other localizations (PϽ0.001). In addition, 5 patients with R-MCA insular lesions died suddenly compared with 2 patients with left-middle cerebral artery insular lesions during hospitalization. Both sympathetic-and parasympathetic-controlled HRV were decreased in patients with ischemic stroke. The most pronounced decrease was found in the territory of R-MCA insular cortex, which suggests that cardiac autonomic tone may be regulated by insula and that these patients are more prone to cardiac complications such as arrhythmias and sudden death due to autonomic imbalance. Conclusion-We conclude that stroke in the region of insula (especially the right) leads to decreased HRV and to increased incidence of sudden death.

Efficacy of rehabilitation robotics for walking training in neurological disorders: A review

“…In patients with stroke, a disturbance in the autonomic functions caused by the lesion was often described to affect physiological processes in cerebrovascular diseases [38][39][40]. In the context of a decrease in HRV, i.e., SD of RR intervals, we found low frequency and high frequency for patients with stroke [38,40]. In addition, Korpelainen et al showed that skin temperature …”

Blood pressure variability and prognosis in acute ischemic stroke with vascular compression on the rostral ventrolateral medulla (RVLM)

“…Finally, the correlation with ischemic location was not fully investigated. A previous study demonstrated that patients with infarctions involving the insular cortex tended to suffer from autonomic dysfunction, 31 which may influence blood pressure. However, in the present study, few patients had infarctions involving the insular cortex, and the proportion of patients with infarctions involving the insular cortex was similar between the compression and non-compression groups (two in the compression group (13.3%) and five in the non-compression group (12.2%)).…”

Препараты Метаболического Действия В Комплексной Терапии Цереброкардиального Синдрома При Ишемическом Инсульте

“…Cнижение ВРС более выраженно при правосторонней локализации церебрально-го поражения. При этом самые низкие значения ВРС регистрировались при вовлечении в патологический очаг правого островка [265]. При пра-восторонней локализации инсульта независимо от поражения островко-вой доли имеется стойкий дефицит вегетативной регуляции, в большей степени за счет парасимпатической составляющей, что может быть свя-зано с более неблагоприятным прогнозом [115].…”

“…По данным литературы [36, 114] низкие показатели ВРС выявля-ются при правосторонней локализации церебрального поражения, и в вертебрально-базилярной системе, особенно при поражении правого островка (островка Рейля) [265].…”