Prognostic relevance of pathological sympathetic activation after acute thromboembolic stroke

Abstract

The involvement of the insular cortex, the occurrence of a pathologic nighttime blood pressure increase, and an initially increased serum norepinephrine concentration are independent predictors of poor long-term outcome.

Sympathetic Overdrive and Cardiovascular Risk in the Metabolic Syndrome

“…This has been shown, for example, in patients with congestive heart failure, in which indirect and direct markers of systemic and regional sympathetic drive (venous plasma norepinephrine, heart rate variability, heart rate spectral power, cardiac and renal norepinephrine spillover) have been documented to bear a close and direct relationship with cardiovascular mortality, disease progression and arrhythmic events, including sudden death (46)(47)(48)(49)(50)(51). Similar conclusions have been drawn by assessing the prognostic values of plasma norepinephrine or heart rate variability in the post-stroke phase following an acute myocardial infarction or in patients with vasospastic angina (52)(53)(54)(55). Finally, dysfunction in sympathetic cardiovascular control has also been shown to have prognostic value in non-cardiovascular diseases such as diabetes mellitus and renal failure (56,57), thereby documenting the clinical relevance of the neuroadrenergic overdrive in a broad spectrum of pathological states.…”

Percentage Insula Ribbon Infarction of >50% Identifies Patients Likely to Have Poor Clinical Outcome Despite Small DWI Infarct Volume

“…Clinical and experimental investigations indicate that there is increased sympathetic nervous system activity, including increased plasma catecholamine levels, in insula infarcts. 5,16 Some of the effects of sympathetic system activation have been associated with adverse clinical or tissue outcome in cerebral ischemia. For example, an elevated norepinephrine concentration after stroke is a predictor of insula involvement and poor neurologic outcome, 16 and likewise poststroke hyperglycemia occurs more often with insular infarcts and is associated with larger infarct size and poor neurologic outcome.…”

“…5,16 Some of the effects of sympathetic system activation have been associated with adverse clinical or tissue outcome in cerebral ischemia. For example, an elevated norepinephrine concentration after stroke is a predictor of insula involvement and poor neurologic outcome, 16 and likewise poststroke hyperglycemia occurs more often with insular infarcts and is associated with larger infarct size and poor neurologic outcome. 5,17 A recent study by Kemmling et al 18 found a significant association between the development of hospital-acquired pneumonia in the setting of right hemispheric peri-insular strokes, an association that is thought to be related to autonomic modulation of the immune system.…”

Plasma catecholamines: follow-up on 10-year study in health and cardiovascular disease

“…A higher rate of cardiovascular and cerebrovascular events in patients with initially increased NE concentrations was reported after 1-year follow-up by Sander et al [25] who studied 112 consecutive patients with their first brain infarction. Plasma NE also reportedly emerged as an independent predictor of fatal and non-fatal cardiovascular events in patients with end-stage renal disease in a study by Zoccali et al [26].…”