Acute autonomic dysfunction contralateral to acute strokes: a prospective study of 100 consecutive cases.

Details

Serval ID
serval:BIB_69D65CEE6382
Type
Article: article from journal or magazin.
Collection
Publications
Title
Acute autonomic dysfunction contralateral to acute strokes: a prospective study of 100 consecutive cases.
Journal
European Journal of Neurology
Author(s)
Diserens K., Vuadens P., Michel P., Reichhart M., Herrmann F.R., Arnold P., Bogousslavsky J., Ghika J.
ISSN
1468-1331[electronic]
Publication state
Published
Issued date
2006
Peer-reviewed
Oui
Volume
13
Number
11
Pages
1245-1250
Language
english
Abstract
Complex painful reflex syndrome is sometimes described in the chronic phase of stroke. Acute autonomic dysfunction (AAD), which is occasionally present in cases of acute stroke, has not been studied prospectively. The aim of the study was to investigate AAD on the hemibody contralateral to the lesion in the acute phase of stroke. One hundred consecutive patients (median age +/- interquartile range, 74 +/- 21; range 19-93; 51 women: 80 +/- 17 and 49 men: 70 +/- 17 years) in the acute phase of stroke were studied prospectively. Changes in skin temperature or coloration, diaphoresis, pain, or edema were noted in the first 3 days post-stroke. Associations between AAD and topography (cortical pre- and/or post-central, insular, corona radiata, basal ganglia, internal capsule, thalamus, and brainstem), age, gender, ischemic or hemorrhagic etiology, or the presence of sensorimotor deficits or ataxia were examined using the chi-squared or Fisher's exact test and logistic regression analysis. AAD was found in 71% of the patients and showed a significant positive association with the presence of a lesion in the post-central cortex (P = 0.037), internal capsule (P = 0.005), basal ganglia (P = 0.002), or insula (P = 0.011) and a negative association with the presence of a lesion in the brainstem (P = 0.004). Multivariate logistic regression analysis including all studied topographic variables showed that only brainstem lesions were significantly associated with a decreased risk of developing AAD (odds ratio = 0.08, 95% confidence interval: 0.01-0.69, P = 0.022). AAD was not associated with age, gender, the ischemic or hemorrhagic nature of the lesion, the side of lesion, hypertonic or hypotonic paresis, or hyperreflexia or hyporeflexia. AAD was found in association with sensory deficits (P = 0.001) and contralateral hyperkinesia (P = 0.004). Acute AAD is significantly more likely to occur in the presence of hemispheric lesions involving sensory pathways from the cortex to the internal capsule and insula and is significantly less prevalent in the presence of brainstem lesions.
Keywords
Acute Disease, Adult, Afferent Pathways/pathology, Afferent Pathways/radiography, Aged, Aged, 80 and over, Autonomic Nervous System Diseases/complications, Autonomic Nervous System Diseases/diagnosis, Brain Stem/pathology, Brain Stem/radiography, Cerebral Cortex/pathology, Cerebral Cortex/radiography, Female, Humans, Internal Capsule/pathology, Internal Capsule/radiography, Magnetic Resonance Imaging, Male, Middle Aged, Muscle Spasticity/etiology, Nervous System Diseases/etiology, Neurologic Examination, Physical Examination, Prospective Studies, Sensation, Sensation Disorders/etiology, Stroke/complications, Stroke/diagnosis, Tomography, X-Ray Computed
Pubmed
Web of science
Create date
25/01/2008 12:45
Last modification date
20/08/2019 15:24
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