Department of Neurology, Haeundae-Paik Hospital, College of Medicine, Inje University, Busan, Korea.
Acta Neurol Scand. 2018 Jul;138(1):32-40. doi: 10.1111/ane.12913. Epub 2018 Feb 21.
Neurological progression is a major problem in managing the patients with acute lacunar infarction. The purpose of this was to investigate whether autonomic dysfunction is associated with neurological progression in patients with acute lacunar infarction.
The study comprised 60 patients with acute lacunar infarction. All enrolled subjects underwent autonomic function tests including the 30° head-up tilt test, Valsalva test, heart rate response to deep breathing, and sympathetic skin response. The primary endpoint is the neurological progression, and the secondary endpoint is the 3-month outcome.
Increased initial National Institute of Health stroke scale (NIHSS), decreased time to admission from onset, decreased rise of heart rate in the 30° head-up tilt test, abnormal blood pressure response in the Valsalva test, and decreased rise of systolic blood pressure in stage IV of the Valsalva test are associated with neurological progression of acute lacunar infarction; an abnormal blood pressure response in the Valsalva test is significant in logistic regression analysis of neurological progression. Advanced age, increased initial NIHSS and modified Rankin scale, decreased expiration/inspiration ratio of heart rate to deep breathing, decreased rise of systolic blood pressure in stage IV of the Valsalva test, and neurological progression were associated with an unfavorable 3-month outcome; neurological progression was significant in logistic regression analysis of 3-month outcome.
An abnormal blood pressure change in the Valsalva test is associated with neurological progression in patients with acute lacunar infarction, and neurological progression can induce an unfavorable 3-month outcome.
神经功能恶化是急性腔隙性脑梗死患者管理中的一个主要问题。本研究旨在探讨自主神经功能障碍与急性腔隙性脑梗死患者神经功能恶化的关系。
本研究纳入了 60 例急性腔隙性脑梗死患者。所有纳入的患者均接受自主神经功能测试，包括 30°头高位倾斜试验、瓦尔萨尔瓦动作试验、心率对深呼吸的反应和交感皮肤反应。主要终点是神经功能恶化，次要终点是 3 个月结局。
初始国立卫生研究院卒中量表（NIHSS）评分升高、从发病到入院的时间缩短、30°头高位倾斜试验中心率升高减少、瓦尔萨尔瓦动作试验中血压反应异常、以及瓦尔萨尔瓦动作试验 IV 期收缩压升高减少与急性腔隙性脑梗死的神经功能恶化有关；在急性腔隙性脑梗死神经功能恶化的逻辑回归分析中，瓦尔萨尔瓦动作试验中的血压反应异常具有统计学意义。高龄、初始 NIHSS 和改良 Rankin 量表评分升高、心率深呼吸时呼气/吸气比值降低、瓦尔萨尔瓦动作试验 IV 期收缩压升高减少以及神经功能恶化与 3 个月结局不良有关；在急性腔隙性脑梗死 3 个月结局的逻辑回归分析中，神经功能恶化具有统计学意义。
瓦尔萨尔瓦动作试验中的血压变化异常与急性腔隙性脑梗死患者的神经功能恶化有关，而神经功能恶化可导致 3 个月结局不良。
