Preliminary findings of the effects of autonomic dysfunction on functional outcome after acute ischemic stroke

Clin Neurol Neurosurg. 2012 May;114(4):316-20. doi: 10.1016/j.clineuro.2011.10.037. Epub 2011 Nov 15.


Background and purpose: Impaired autonomic function is common in the acute poststroke phase but little is known about its effects on functional outcome after acute ischemic stroke. This study sought to investigate the impact of autonomic dysfunction by Ewing's classification on functional outcome 2 months after acute ischemic stroke.

Methods: 34 consecutive acute ischemic stroke patients within 7 days after onset were enrolled. On admission, autonomic function was assessed by Ewing's battery tests. Stroke severity was assessed by the National Institutes of Health Stroke Scale (NIHSS), autonomy in activities of daily living by the Barthel Index (BI), and global disability by the modified Rankin Scale (mRS). BI and mRS were also evaluated 2 months after ischemic stroke onset.

Results: On admission, eight patients were diagnosed as minor autonomic dysfunction and 26 patients as relatively severe autonomic dysfunction. The prevalence of relatively severe autonomic dysfunction in ischemic stroke patients was 76.5%. There were no significant differences in baseline characteristics between the minor and severe autonomic dysfunction groups. 2 months after stroke onset, the mean BI score of patients with minor autonomic dysfunction and severe autonomic dysfunction increased from 76.3±15.3 on admission to 95.0±7.1, 66.5±15.2 on admission to 74.8±15.9 respectively. The mean BI score after 2-month stroke onset and the change in BI from admission to 2-month outcome (delta BI) in patients with severe autonomic dysfunction were lower than those in patients with minor autonomic dysfunction (all P<0.05).

Conclusions: Autonomic dysfunction occurs in acute stroke patients. Relatively severe autonomic dysfunction is related to an unfavorable functional outcome in patients with acute ischemic stroke.

MeSH terms

  • Aged
  • Arrhythmia, Sinus / physiopathology
  • Autonomic Nervous System Diseases / complications*
  • Brain Ischemia / complications*
  • Brain Ischemia / physiopathology
  • Female
  • Heart Diseases / complications
  • Heart Diseases / physiopathology
  • Heart Rate / physiology
  • Humans
  • Hypotension, Orthostatic / physiopathology
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Prospective Studies
  • Recovery of Function
  • Respiration
  • Stroke / complications*
  • Stroke / physiopathology
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Valsalva Maneuver