Skip to main content
Top
Published in: Neurological Sciences 6/2024

21-01-2024 | Stroke | Review Article

Dysautonomia and activity in the early stroke recovery period

Authors: Amelia Tenberg, Nozomi Tahara, Amit Grewal, Alison Herrera, Lisa M. Klein, Rachael Lebo, Elizabeth K. Zink, Mona N. Bahouth

Published in: Neurological Sciences | Issue 6/2024

Login to get access

Abstract

Maintaining cerebral perfusion in the early stages of recovery after stroke is paramount. Autoregulatory function may be impaired during this period leaving cerebral perfusion directly reliant on intravascular volume and blood pressure (BP) with increased risk for expanding cerebral infarction during periods of low BP and hemorrhagic transformation during BP elevations. We suspected that dysautonomia is common during the acute period related to both pre-existing vascular risk factors and potentially independent of such conditions. Thus, we sought to understand the state of the science specific to dysautonomia and acute stroke. The scoping review search included multiple databases and key terms related to acute stroke and dysautonomia. The team employed a rigorous review process to identify, evaluate, and summarize relevant literature. We additionally summarized common clinical approaches used to detect dysautonomia at the bedside. The purpose of this scoping review is to understand the state of the science for the identification, treatment, and impact of dysautonomia on acute stroke patient outcomes. There is a high prevalence of dysautonomia among persons with stroke, though there is significant variability in the type of measures and definitions used to diagnose dysautonomia. While dysautonomia appears to be associated with poor functional outcome and post-stroke complications, there is a paucity of high-quality evidence, and generalizability is limited by heterogenous approaches to these studies. There is a need to establish common definitions, standard measurement tools, and a roadmap for incorporating these measures into clinical practice so that larger studies can be conducted.
Appendix
Available only for authorised users
Literature
2.
go back to reference Al-Qudah ZA, Yacoub HA, Souayah N (2015) Disorders of the autonomic nervous system after hemispheric cerebrovascular disorders: an update. J Vasc Interv Neurol 8(4):43–52PubMedPubMedCentral Al-Qudah ZA, Yacoub HA, Souayah N (2015) Disorders of the autonomic nervous system after hemispheric cerebrovascular disorders: an update. J Vasc Interv Neurol 8(4):43–52PubMedPubMedCentral
7.
go back to reference Guyatt G, Rennie D, Meade M, Cook D (eds) (2002) Users’ guides to the medical literature: a manual for evidence-based clinical practice, vol 706. AMA Press, Chicago Guyatt G, Rennie D, Meade M, Cook D (eds) (2002) Users’ guides to the medical literature: a manual for evidence-based clinical practice, vol 706. AMA Press, Chicago
8.
go back to reference Richardson WS, Wilson MC, Nishikawa J, Hayward RS (1995) The well-built clinical question: a key to evidence-based decisions. ACP J Club 123(3):A12–A13CrossRefPubMed Richardson WS, Wilson MC, Nishikawa J, Hayward RS (1995) The well-built clinical question: a key to evidence-based decisions. ACP J Club 123(3):A12–A13CrossRefPubMed
11.
go back to reference Deng D, Dearholt SL, Bissett K, Ascenzi J, Whalen M (2017) Johns Hopkins nursing evidence-based practice for nurses and healthcare professionals: model and guidelines, 4th Edition. Sigma Theta Tau International, Indianapolis Deng D, Dearholt SL, Bissett K, Ascenzi J, Whalen M (2017) Johns Hopkins nursing evidence-based practice for nurses and healthcare professionals: model and guidelines, 4th Edition. Sigma Theta Tau International, Indianapolis
18.
go back to reference Lin CH, Yen CC, Hsu YT, Chen HH, Cheng PW, Tseng CJ et al (2019) Baroreceptor sensitivity predicts functional outcome and complications after acute ischemic stroke. J Clin Med 8(3):300CrossRefPubMedPubMedCentral Lin CH, Yen CC, Hsu YT, Chen HH, Cheng PW, Tseng CJ et al (2019) Baroreceptor sensitivity predicts functional outcome and complications after acute ischemic stroke. J Clin Med 8(3):300CrossRefPubMedPubMedCentral
26.
go back to reference Xiong L, Tiang G, Leung H, Chen X, Lin W, Leung T, Soo YO, Siu D, Wong L (2019) Autonomic dysfunction as measured by Ewing’s battery test to predict poor outcome after acute ischemic stroke. Hong Kong Med J 25(4):S9-11 Xiong L, Tiang G, Leung H, Chen X, Lin W, Leung T, Soo YO, Siu D, Wong L (2019) Autonomic dysfunction as measured by Ewing’s battery test to predict poor outcome after acute ischemic stroke. Hong Kong Med J 25(4):S9-11
27.
go back to reference Zeng QH, Jiang YL, Wang Y, Nie HX, Zhou F, Yu SH, Zhuang AX, Wang CQ, Peng YY, Zhang HJ (2017) The correlation between noradrenaline and acetylcholine levels and autonomic nervous system dysfunction in patients with stroke-associated pneumonia. Int J Clin Exp Med 10(10):14761–14769 Zeng QH, Jiang YL, Wang Y, Nie HX, Zhou F, Yu SH, Zhuang AX, Wang CQ, Peng YY, Zhang HJ (2017) The correlation between noradrenaline and acetylcholine levels and autonomic nervous system dysfunction in patients with stroke-associated pneumonia. Int J Clin Exp Med 10(10):14761–14769
38.
go back to reference Sander D, Klingelhöfer J (1994) Changes of circadian blood pressure patterns after hemodynamic and thromboembolic brain infarction. Stroke 25(9):1730–1737CrossRefPubMed Sander D, Klingelhöfer J (1994) Changes of circadian blood pressure patterns after hemodynamic and thromboembolic brain infarction. Stroke 25(9):1730–1737CrossRefPubMed
41.
go back to reference Meyer S, Strittmatter M, Fischer C, Georg T, Schmitz B (2004) Lateralization in autonomic dysfunction in ischemic stroke involving the insular cortex. NeuroReport 15(2):357–361CrossRefPubMed Meyer S, Strittmatter M, Fischer C, Georg T, Schmitz B (2004) Lateralization in autonomic dysfunction in ischemic stroke involving the insular cortex. NeuroReport 15(2):357–361CrossRefPubMed
45.
go back to reference Ewing DJ, Clarke BF (1982) Diagnosis and management of diabetic autonomic neuropathy. Br Med J 285:916–918CrossRef Ewing DJ, Clarke BF (1982) Diagnosis and management of diabetic autonomic neuropathy. Br Med J 285:916–918CrossRef
46.
go back to reference Kapoor WN, Smith MA, Miller NL (1994) Upright tilt testing in evaluating syncope: a comprehensive literature review. Am J Med 97(1):78–88CrossRefPubMed Kapoor WN, Smith MA, Miller NL (1994) Upright tilt testing in evaluating syncope: a comprehensive literature review. Am J Med 97(1):78–88CrossRefPubMed
Metadata
Title
Dysautonomia and activity in the early stroke recovery period
Authors
Amelia Tenberg
Nozomi Tahara
Amit Grewal
Alison Herrera
Lisa M. Klein
Rachael Lebo
Elizabeth K. Zink
Mona N. Bahouth
Publication date
21-01-2024
Publisher
Springer International Publishing
Published in
Neurological Sciences / Issue 6/2024
Print ISSN: 1590-1874
Electronic ISSN: 1590-3478
DOI
https://doi.org/10.1007/s10072-023-07289-4

Other articles of this Issue 6/2024

Neurological Sciences 6/2024 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine