Prognostic relevance of pathological sympathetic activation after acute thromboembolic stroke

被引:195
作者
Sander, D
Winbeck, K
Klingelhöfer, J
Etgen, T
Conrad, B
机构
[1] Tech Univ Munich, Dept Neurol, D-81675 Munich, Germany
[2] Klinikum Chemnitz, Chemnitz, Germany
关键词
D O I
10.1212/WNL.57.5.833
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objective: To evaluate the prognostic impact of early pathologic sympathetic activation after stroke. Methods: The authors examined 112 consecutive patients (mean age, 69 years; 60 men) with their first brain infarction. A pathologic sympathetic activation was presumed if the initial norepinephrine level exceeds 300 pg/mL. In addition, involvement of the insular cortex, nighttime blood pressure changes, and several cardiovascular risk factors were determined. One-year outcome measures were mortality rate, cardiovascular and cerebrovascular events, and activities of daily living (Barthel index and Rankin score). Results: Norepinephrine levels greater than 300 pg/mL, nighttime blood pressure increases, and insular involvement were associated with a lower Barthel index (p < 0.005) at the 1-year follow-up. By stepwise logistic regression analysis, insular infarction, serum norepinephrine concentration, right-sided infarction, and nighttime blood pressure increase were significant and independent predictors of an unfavorable functional outcome. Cox regression analysis showed a higher rate of cardiovascular and cerebrovascular events (hazard ratio, 2.9; 95% CI, 1.07; 6.83; p < 0.04) in patients with initially increased norepinephrine concentrations. Conclusions: 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.
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页码:833 / 838
页数:6
相关论文
共 36 条
[31]   Relationship between circadian blood pressure patterns and progression of early carotid atherosclerosis -: A 3-year follow-up study [J].
Sander, D ;
Kukla, C ;
Klingelhöfer, J ;
Winbeck, K ;
Conrad, B .
CIRCULATION, 2000, 102 (13) :1536-1541
[32]   CHANGES IN PLASMA-CATECHOLAMINE LEVELS AFTER INSULA DAMAGE IN EXPERIMENTAL STROKE [J].
SMITH, KE ;
HACHINSKI, VC ;
GIBSON, CJ ;
CIRIELLO, J .
BRAIN RESEARCH, 1986, 375 (01) :182-185
[33]  
Talairach G., 1988, Planar Stereotaxic Atlas of the Human Brain
[34]   Effects of stroke localization on cardiac autonomic balance and sudden death [J].
Tokgözoglu, SL ;
Batur, MK ;
Topçuoglu, MA ;
Saribas, O ;
Kes, S ;
Oto, A .
STROKE, 1999, 30 (07) :1307-1311
[35]  
Verdecchia, 1996, Blood Press Monit, V1, P3
[36]   ASSESSMENT OF 4 AMBULATORY BLOOD-PRESSURE MONITORS AND MEASUREMENTS BY CLINICIANS VERSUS INTRAARTERIAL BLOOD-PRESSURE AT REST AND DURING EXERCISE [J].
WHITE, WB ;
LUNDJOHANSEN, P ;
OMVIK, P .
AMERICAN JOURNAL OF CARDIOLOGY, 1990, 65 (01) :60-66