Seifert Frank, Kallmünzer Bernd, Gutjahr Isabell, Breuer Lorenz, Winder Klemens, Kaschka Iris, Kloska Stephan, Doerfler Arnd, Hilz Max-Josef, Schwab Stefan, Köhrmann Martin
Department of Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany,
J Neurol. 2015 May;262(5):1182-90. doi: 10.1007/s00415-015-7684-9. Epub 2015 Mar 4.
Neurocardiological interactions can cause severe cardiac arrhythmias in patients with acute ischemic stroke. The relationship between the lesion location in the brain and the occurrence of cardiac arrhythmias is still discussed controversially. The aim of the present study was to correlate the lesion location with the occurrence of cardiac arrhythmias in patients with acute ischemic stroke. Cardiac arrhythmias were systematically assessed in patients with acute ischemic stroke during the first 72 h after admission to a monitored stroke unit. Voxel-based lesion-symptom mapping (VLSM) was used to correlate the lesion location with the occurrence of clinically relevant severe arrhythmias. Overall 150 patients, 56 with right-hemispheric and 94 patients with a left-hemispheric lesion, were eligible to be included in the VLSM study. Severe cardiac arrhythmias were present in 49 of these 150 patients (32.7%). We found a significant association (FDR correction, q < 0.05) between lesions in the right insular, right frontal and right parietal cortex as well as the right amygdala, basal ganglia and thalamus and the occurrence of cardiac arrhythmias. Because left- and right-hemispheric lesions were analyzed separately, the significant findings rely on the 56 patients with right-hemispheric lesions. The data indicate that these areas are involved in central autonomic processing and that right-hemispheric lesions located to these areas are associated with an elevated risk for severe cardiac arrhythmias.
神经心脏相互作用可导致急性缺血性中风患者出现严重心律失常。脑内病变位置与心律失常发生之间的关系仍存在争议。本研究的目的是将急性缺血性中风患者的病变位置与心律失常的发生相关联。在急性缺血性中风患者入住有监测设备的中风单元后的头72小时内，对心律失常进行了系统评估。基于体素的病变-症状映射（VLSM）用于将病变位置与临床相关严重心律失常的发生相关联。共有150例患者符合纳入VLSM研究的条件，其中56例为右半球病变患者，94例为左半球病变患者。这150例患者中有49例（32.7%）出现了严重心律失常。我们发现，右侧岛叶、右侧额叶和右侧顶叶皮质以及右侧杏仁核、基底神经节和丘脑的病变与心律失常的发生之间存在显著关联（FDR校正，q<0.05）。由于分别对左半球和右半球病变进行了分析，显著发现依赖于56例右半球病变患者。数据表明，这些区域参与中枢自主神经处理，位于这些区域的右半球病变与严重心律失常风险升高相关。
