Clinical Stroke Research Unit, Department of Neurology, Rigshospitalet, University of Copenhagen, Valdemar Hansens Vej 1-23, 2600, Rigshospitalet, Denmark.
Section On Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
BMC Neurol. 2023 Jan 17;23(1):26. doi: 10.1186/s12883-023-03054-4.
Autonomic dysfunction is prevalent in ischemic stroke patients and associated with a worse clinical outcome. We aimed to evaluate autonomic dysfunction over time and the tolerability of the head-up tilt table test in an acute stroke setting to optimize patient care.
In a prospective observational cohort study, patients were consecutively recruited from an acute stroke unit. The patients underwent heart rate and blood pressure analysis during the Valsalva maneuver, deep breathing, active standing, and head-up tilt table test if active standing was tolerated. In addition, heart rate variability and catecholamines were measured. All tests were performed within seven days after index ischemic stroke and repeated at six months follow-up.
The cohort was comprised of 91 acute stroke patients, mean (SD) age 66 (11) years, median (IQR) initial National Institute of Health Stroke Scale 2 (1-4) and modified Ranking Scale 2 (1-3). The head-up tilt table test revealed 7 patients (10%) with orthostatic hypotension. The examination was terminated before it was completed in 15%, but none developed neurological symptoms. In the acute state the prevalence of autonomic dysfunction varied between 10-100% depending on the test. No changes were found in presence and severity of autonomic dysfunction over time.
In this cohort study of patients with mild stroke, autonomic dysfunction was highly prevalent and persisted six months after index stroke. Head-up tilt table test may be used in patients who tolerate active standing. Autonomic dysfunction should be recognized and handled in the early phase after stroke.
自主神经功能障碍在缺血性脑卒中患者中较为常见，且与更差的临床预后相关。我们旨在评估急性脑卒中患者自主神经功能障碍随时间的变化，并评估直立倾斜试验的耐受性，以便优化患者的治疗。
在一项前瞻性观察性队列研究中，连续招募来自急性脑卒中病房的患者。患者在进行瓦尔萨尔瓦动作、深呼吸、主动站立时接受心率和血压分析，如果能耐受主动站立，则进行直立倾斜试验。此外，还测量了心率变异性和儿茶酚胺。所有检查均在指数缺血性脑卒中后 7 天内进行，并在 6 个月的随访中重复进行。
该队列由 91 例急性脑卒中患者组成，平均（SD）年龄为 66（11）岁，中位数（IQR）初始国立卫生研究院脑卒中量表为 2（1-4），改良Rankin量表为 2（1-3）。直立倾斜试验发现 7 例（10%）患者出现体位性低血压。在 15%的患者中，检查在完成前被终止，但无一例出现神经系统症状。在急性期，根据测试的不同，自主神经功能障碍的发生率在 10%至 100%之间变化。在随访期间，自主神经功能障碍的存在和严重程度没有变化。
在这项轻度脑卒中患者的队列研究中，自主神经功能障碍的发生率很高，并在指数性脑卒中后持续 6 个月。直立倾斜试验可用于能耐受主动站立的患者。应在脑卒中后早期识别和处理自主神经功能障碍。
