Article

Autonomic dysfunction is a common complication of cerebrovascular disease. The aim of this study was to investigate the activity of the sympathetic nervous system, and cardiovascular system in acute cerebral ischemia. Patients and methods: 55 patients with cerebral ischemia (onset of symptoms < 24 h prior to admission) were included into a prospective study (mean age 61.3 ± 1.5). Neurologic score was assessed using the Scandinavian Stroke Scale Score (SSSS). Cardiac output, mean transcranial flow velocity in the middle cerebral artery, systolic and diastolic blood pressure, and heart rate were recorded. Plasma norepinephrine (NE) and epinephrine (E) concentrations were measured with high performance liquid chromatography (concentration in ng/l). Data was obtained during the first 5 days after stroke. Values are given as mean ± standard error of the mean. Results: Cerebral ischemia caused an increase in sympathetic function in the acute phase (NE: 523.1 ± 60.0) with a significant spontaneous decrease (NE on day 5: 399.1 ± 47.7). The alterations in autonomic function were paralleled by augmented cardiovascular parameters. Systolic and diastolic blood pressure, and heart rate showed a significant drop. Cardiac output, on the contrary, exhibited a significant increase which was inversely correlated to initial values. The most significant correlations existed between NE, E and systolic and diastolic blood pressure. Heart rate was predominantly modulated via the adrenergic axis. In hemispheric ischemia, mean transcranial flow velocity was higher on the affected side. Conclusion: Our study shows that cerebral ischemia in the acute post-ischemic phase is accompanied by autonomic and cardiovascular dysfunction. The increase in cardiac output is possibly due to a spontaneous drop in systemic afterload. We conclude that plasma catecholamines are a feasible means in monitoring changes of cardio-autonomic function in acute cerebral ischemia.

Langue : ALLEMAND

Tiré à part : OUI

Identifiant basis : 2001217226