Autonomic Disturbances in Acute Cerebrovascular Disease
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摘要
Autonomic disturbances often occur in patients with acute cerebrovascular disease due to damage of the central autonomic network. We summarize the structures of the central autonomic network and the clinical tests used to evaluate the functions of the autonomic nervous system.We review the clinical and experimental findings as well as management strategies of post-stroke autonomic disturbances including electrocardiographic changes, cardiac arrhythmias, myocardial damage, thermoregulatory dysfunction, gastrointestinal dysfunction, urinary incontinence, sexual disorders, and hyperglycemia. The occurrence of autonomic disturbances has been associated with poor outcomes in stroke patients. Autonomic nervous system modulation appears to be an emerging therapeutic strategy for stroke management in addition to treatments for sensorimotor dysfunction.
Autonomic disturbances often occur in patients with acute cerebrovascular disease due to damage of the central autonomic network. We summarize the structures of the central autonomic network and the clinical tests used to evaluate the functions of the autonomic nervous system.We review the clinical and experimental findings as well as management strategies of post-stroke autonomic disturbances including electrocardiographic changes, cardiac arrhythmias, myocardial damage, thermoregulatory dysfunction, gastrointestinal dysfunction, urinary incontinence, sexual disorders, and hyperglycemia. The occurrence of autonomic disturbances has been associated with poor outcomes in stroke patients. Autonomic nervous system modulation appears to be an emerging therapeutic strategy for stroke management in addition to treatments for sensorimotor dysfunction.
Autonomic disturbances often occur in patients with acute cerebrovascular disease due to damage of the central autonomic network. We summarize the structures of the central autonomic network and the clinical tests used to evaluate the functions of the autonomic nervous system.We review the clinical and experimental findings as well as management strategies of post-stroke autonomic disturbances including electrocardiographic changes, cardiac arrhythmias, myocardial damage, thermoregulatory dysfunction, gastrointestinal dysfunction, urinary incontinence, sexual disorders, and hyperglycemia. The occurrence of autonomic disturbances has been associated with poor outcomes in stroke patients. Autonomic nervous system modulation appears to be an emerging therapeutic strategy for stroke management in addition to treatments for sensorimotor dysfunction.
引文
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2.McLaren A,Kerr S,Allan L,Steen IN,Ballard C,Allen J,et al.Autonomic function is impaired in elderly stroke survivors.Stroke 2005,36:1026-1030.
3.Korpelainen JT,Sotaniemi KA,Myllyla¨VV.Autonomic nervous system disorders in stroke.Clin Auton Res 1999,9:325-333.
4.Al-Qudah ZA,Yacoub HA,Souayah N.Disorders of the autonomic nervous system after hemispheric cerebrovascular disorders:an update.J Vasc Interv Neurol 2015,8:43-52.
5.Cersosimo MG,Benarroch EE.Central control of autonomic function and involvement in neurodegenerative disorders.In:Handbook of Clinical Neurology.3rd ed.Elsevier,2013:45-57.
6.Benarroch EE.The autonomic nervous system:basic anatomy and physiology.Continuum 2007,13:13-32.
7.Bankenahally R,Krovvidi H.Autonomic nervous system:anatomy,physiology,and relevance in anaesthesia and critical care medicine.BJA Educ 2016,16:381-387.
8.Alawieh A,Tomlinson S,Adkins D,Kautz S,Feng W.Preclinical and clinical evidence on ipsilateral corticospinal projections:implication for motor recovery.Transl Stroke Res2017,8:529-540.
9.Sykora M,Diedler J,Turcani P,Hacke W,Steiner T.Baroreflex:a new therapeutic target in human stroke?Stroke 2009,40:e678-e682.
10.Benarroch EE.The central autonomic network:functional organization,dysfunction,and perspective.Mayo Clin Proc1993,68:988-1001.
11.Craig A.A new view of pain as a homeostatic emotion.Trends Neurosci 2003,26:303-307.
12.Saper CB.The central autonomic nervous system:conscious visceral perception and autonomic pattern generation.Annu Rev Neurosci 2002,25:433-469.
13.Lu C,Yang T,Zhao H,Zhang M,Meng F,Fu H,et al.Insular cortex is critical for the perception,modulation,and chronification of pain.Neurosci Bull 2016,32:191-201.
14.Reddan MC,Wager TD.Modeling pain using fMRI:from regions to biomarkers.Neurosci Bull 2018,34:208-215.
15.Nagai M,Hoshide S,Kario K.The insular cortex and cardiovascular system:a new insight into the brain-heart axis.J Am Soc Hypertens 2010,4:174-182.
16.Critchley HD.Psychophysiology of neural,cognitive and affective integration:fMRI and autonomic indicants.Int JPsychophysiol 2009,73:88-94.
17.Vogt BA,Vogt L,Farber NB,Bush G.Architecture and neurocytology of monkey cingulate gyrus.J Comp Neurol 2005,485:218-239.
18.LeDoux J.The amygdala.Curr Biol 2007,17:R868-R874.
19.Davis M.The role of the amygdala in fear and anxiety.Annu Rev Neurosci 1992,15:353-375.
20.Misslin R.The defense system of fear:behavior and neurocircuitry.Neurophysiol Clin 2003,33:55-66.
21.Benarroch EE.Central autonomic control.In:Robertson D,Biaggioni I,Burnstock G,Low PA,Paton JFR(Ed.).Primer on the Autonomic Nervous System.3rd ed.Academic Press,2012:9-12.
22.Travagli RA,Hermann GE,Browning KN,Rogers RC.Brainstem circuits regulating gastric function.Annu Rev Physiol2006,68:279-305.
23.Chen L,Li C,Zhai J,Wang A,Song Q,Liu Y,et al.Altered resting-state signals in patients with acute stroke in or under the thalamus.Neurosci Bull 2016,32:585-590.
24.Dampney RAL,Horiuchi J.Functional organisation of central cardiovascular pathways:studies using c-fos gene expression.Prog Neurobiol 2003,71:359-384.
25.McLeod JG,Tuck RR.Disorders of the autonomic nervous system:part 2.Investigation and treatment.Ann Neurol 1987,21:519-529.
26.Low PA.Testing the autonomic nervous system.Semin Neurol2003,23:407-422.
27.Zygmunt A,Stanczyk J.Methods of evaluation of autonomic nervous system function.Arch Med Sci 2010,6:11-18.
28.Korpelainen JT,Sotaniemi KA,Huikuri HV,Myllyla¨VV.Abnormal heart rate variability as a manifestation of autonomic dysfunction in hemispheric brain infarction.Stroke 1996,27:2059-2063.
29.Yperzeele L,van Hooff RJ,Nagels G,De Smedt A,De Keyser J,Brouns R.Heart rate variability and baroreceptor sensitivity in acute stroke:a systematic review.Int J Stroke 2015,10:796-800.
30.De Raedt S,De Vos A,De Keyser J.Autonomic dysfunction in acute ischemic stroke:an underexplored therapeutic area?J Neurol Sci 2015,348:24-34.
31.Cohen J,Low P,Fealey R,Sheps S,Jiang NS.Somatic and autonomic function in progressive autonomic failure and multiple system atrophy.Ann Neurol 1987,22:692-699.
32.Myers MG,Norris JW,Hachniski VC,Sole MJ.Plasma norepinephrine in stroke.Stroke 1981,12:200-204.
33.Naredi S,Lambert G,Ede′n E,Za¨ll S,Runnerstam M,Rydenhag B,et al.Increased sympathetic nervous activity in patients with nontraumatic subarachnoid hemorrhage.Stroke 2000,31:901-906.
34.Togha M,Sharifpour A,Ashraf H,Moghadam M,Sahraian MA.Electrocardiographic abnormalities in acute cerebrovascular events in patients with/without cardiovascular disease.Ann Indian Acad Neurol 2013,16:66-71.
35.Ramani A,Shetty U,Kundaje GN.Electrocardiographic abnormalities in cerebrovascular accidents.Angiology 1990,41:681-686.
36.Raad B,Sila C.Cardiac manifestations of neurologic disorders.Continuum 2011,17:13-26.
37.Ay H,Koroshetz WJ,Benner T,Vangel MG,Melinosky C,Arsava EM,et al.Neuroanatomic correlates of stroke-related myocardial injury.Neurology 2006,66:1325-1329.
38.Cechetto DF,Hachinski V.Cardiovascular consequence of experimental stroke.Baillieres Clin Neurol 1997,6:297-308.
39.Oppenheimer S.The insular cortex and the pathophysiology of stroke-induced cardiac changes.Can J Neurol Sci 1992,19:208-211.
40.Rincon F,Dhamoon M,Moon Y,Paik MC,Boden-Albala B,Homma S,et al.Stroke location and association with fatal cardiac outcomes:Northern Manhattan Study(NOMAS).Stroke2008,39:2425-2431.
41.van Bree MDR,Roos YWEM,van der Bilt IAC,Wilde AAM,Sprengers MES,Gans K,et al.Prevalence and characterization of ECG abnormalities after intracerebral hemorrhage.Neurocrit Care 2010,12:50-55.
42.Christensen H,Boysen G,Christensen AF,Johannesen HH.Insular lesions,ECG abnormalities,and outcome in acute stroke.J Neurol Neurosurg Psychiatry 2005,76:269-271.
43.Fure B,Bruun Wyller T,Thommessen B.Electrocardiographic and troponin T changes in acute ischaemic stroke.J Intern Med2006,259:592-597.
44.Cruickshank JM,Neil-Dwyer G,Stott AW.Possible role of catecholamines,corticosteroids,and potassium in production of electrocardiographic abnormalities associated with subarachnoid haemorrhage.Br Heart J 1974,36:697-706.
45.Goldstein DS.The electrocardiogram in stroke:relationship to pathophysiological type and comparison with prior tracings.Stroke 1979,10:253-259.
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