Prognostic relevance of pathological sympathetic activation after acute thromboembolic stroke

Neurology. 2001 Sep 11;57(5):833-8. doi: 10.1212/wnl.57.5.833.


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.

MeSH terms

  • Aged
  • Cerebral Infarction / blood*
  • Cerebral Infarction / complications
  • Confidence Intervals
  • Female
  • Humans
  • Hypertension / blood
  • Hypertension / complications
  • Logistic Models
  • Male
  • Norepinephrine / blood*
  • Odds Ratio
  • Outcome Assessment, Health Care
  • Prognosis
  • Prospective Studies
  • Stroke / blood*
  • Stroke / complications
  • Survival Analysis
  • Sympathetic Nervous System / metabolism*
  • Sympathetic Nervous System / pathology
  • Thromboembolism / blood*
  • Thromboembolism / complications


  • Norepinephrine