Keller C, Williams A
College of Nursing, Arizona State University, Tempe 85287-2602.
J Neurosci Nurs. 1993 Dec;25(6):349-55. doi: 10.1097/01376517-199312000-00005.
Intracranial pathology is frequently associated with cardiac dysrhythmias, which are sometimes lethal. Stroke, subarachnoid hemorrhage, seizures and head trauma with or without increased intracranial pressure are observed to be accompanied by myocardial damage and by ECG abnormalities, including T-wave changes, shortened P-R interval, prolonged Q-T interval, premature ventricular contractions, ventricular ectopy, sinus bradycardia, ventricular and supraventricular tachycardias. Derangements of autonomic function have been shown to be responsible for these disturbances of rate, rhythm and conduction. The autonomic nervous system receives neural input from various parts of the cerebral cortex, the hypothalamus and the brainstem which are extensively interconnected. Although unequivocal data supporting associations between specific neuropathological conditions or damage to specific structures and the observed dysrhythmias do not exist, some evidence for laterality of function does exist in humans. Tachycardia and pressor responses are more common after stimulation of the right insular cortex and after experimental stimulation of the left vagus which innervates the atrioventricular node and the cardiac conduction system. Bradycardia seems to be more common after stimulation of the left insular cortex or the right vagus nerve which innervate the sinoatrial node.
颅内病变常与心脏心律失常相关，有时甚至会致命。中风、蛛网膜下腔出血、癫痫发作以及伴有或不伴有颅内压升高的头部外伤，均被观察到伴有心肌损伤和心电图异常，包括T波改变、P-R间期缩短、Q-T间期延长、室性早搏、室性异位搏动、窦性心动过缓、室性和室上性心动过速。自主神经功能紊乱已被证明是这些心率、节律和传导紊乱的原因。自主神经系统接收来自大脑皮层、下丘脑和脑干等广泛相互连接的各个部位的神经输入。尽管不存在明确支持特定神经病理状况或特定结构损伤与所观察到的心律失常之间关联的数据，但在人类中确实存在一些功能偏侧性的证据。刺激右侧岛叶皮层以及实验性刺激支配房室结和心脏传导系统的左侧迷走神经后，心动过速和升压反应更为常见。刺激支配窦房结的左侧岛叶皮层或右侧迷走神经后，心动过缓似乎更为常见。
