Transient autonomic nervous system dysfunction during hyperacute stroke

Forty-four patients suffering a stroke for the first time were examined wit hin 10 h of the onset of symptoms; the tests performed on their admission t o hospital, and thereafter on the third and seventh day, were 24-h Holter E KG with spectral analysis of heart rate variability, evaluation of arterial blood pressure and the levels of catecholamine in the blood and 24-h urine . The dynamic EKG on admission revealed that 31 (70.5%) out of the 44 patie nts already had arrhythmia. These alterations were observed in 9 (75%) out of 12 haemorrhagic patients with a significant (P < 0.05) prevalence compar ed to 22 (68.8%) of the 32 ischaemic ones. Arrhythmia showed up in 16 (76.2 %) out of 21 cases with right hemisphere lesions and in 12 (63.2%) out of 1 9 cases of left hemisphere lesions; this difference was also significant (P <0.05). Arrhythmia was still present in 19 (43.2%) patients after 3 days an d only in 2 (6.5%) patients after 7 days. The spectral analysis parameters on admission and after 3 days were significantly (P<0.05) modified in patie nts with stroke plus arrhythmia, compared to patients with stroke alone and to control subjects, whereas no further differences were observed on the s eventh day. Moreover, the percentage of patients with arterial hypertension and high levels of catecholamine greatly decreased from the third day onwa rds. A transient autonomic nervous system imbalance with prevalent sympathe tic activity may justify this cardiovascular impairment during the hyperacu te phase of stroke.