Skip to main content
SpringerLink
Log in

Changes of circadian blood pressure patterns and cardiovascular parameters indicate lateralization of sympathetic activation following hemispheric brain infarction

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

The effects of left- and right-sided hemispheric brain infarction on variability in circadian blood pressure and cardiovascular measures were investigated in 35 patients to test for asymmetry of the sympathetic consequences of stroke. No significant differences regarding age, size of infarction or extent and frequency of damage to the insular cortex could be detected between the two groups. Patients with right-sided infarction showed a significantly reduced circadian blood pressure variability [diastolic: -1% (95% CI -4 to 1) vs -6% (-9 to -2);P < 0.05] and a higher frequency of nocturnal blood pressure increase (47% vs 35%;P < 0.05) as compared with patients with left-sided infarction. Right-sided infarction was also associated with higher serum noradrenaline concentrations [546 pg/ml (95% CI 415–677) vs 405 pg/ml (266–544);P < 0.05], and ECG more frequently showed QT prolongation (53% vs 35%;P < 0.05) and cardiac arrhythmias (67% vs 20%;P < 0.005). However, irrespective of the hemisphere damaged, patients with insular infarction showed the most pronounced changes of these parameters. In addition, two patients with right-sided strokes (13%) involving the insula, but none with a left-sided infarction, developed myocardial infarction. These findings suggest lateralization of sympathetic activation with right-sided dominance for sympathetic effects following hemispheric stroke.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Allen GV, DiCarlo MA, Cechetto DF (1992) Changes in the neurochemical organization of forebrain autonomic sites following focal cerebral ischemia. Neurosci Abstr 18: 1173

    Google Scholar 

  2. Ashman R, Hull E (1945) Essentials of electrocardiography. Macmillan, New York

    Google Scholar 

  3. Baumgart P, Walger P, Dorst KG, Eiff M von, Rahn KH, Vetter H (1989) Can secondary hypertension be identified by twenty-four-hour ambulatory pressure monitoring? J Hypertens 7 [Suppl 3]: S25-S28

    Google Scholar 

  4. Bravo EL, Tarazi RC, Gifford RW, Stewart BH (1979) Circulating and urinary catecholamines in pheochromocytoma. N Engl J Med 301: 682–686

    PubMed  Google Scholar 

  5. Campbell MJ, Gardner MJ (1989) Calculating confidence intervals for some non-parametric analysis. In: Gardner MJ, Altmann DG (ed) Statistics with confidence. BMA, London, pp 71–79

    Google Scholar 

  6. Cechetto DF, Wilson JX, Smith KE, Wolski D, Silver MD, Hachinski VC (1989) Autonomic and myocardial changes in middle cerebral artery occlusion: stroke modells in the rat. Brain Res 502:296–305

    PubMed  Google Scholar 

  7. Goldstein DS (1979) The electrocardiogram in stroke: relationship to pathophysiological type and comparison with prior tracings. Stroke 10: 253–259

    PubMed  Google Scholar 

  8. Graettinger WF, Lipson JL, Cheung DG, Weber MA (1988) Validation of portable noninvasive blood pressure monitoring devices: comparisons with intra-arterial and sphygmomanometer measurements. Am Heart J 116: 1155–1160

    PubMed  Google Scholar 

  9. Hachinski HC, Oppenheimer SM, Wilson JX, Guiraudon C, Cechetto DF (1992) Asymmetry of sympathetic consequences of experimental stroke. Arch Neurol 49: 697–702

    PubMed  Google Scholar 

  10. Lindenstrom E, Boysen G, Christiansen LW, Hansen BR, Nielsen PWC (1991) Reliability of Scandinavian Neurological Stroke Scale. Cerebrovasc Dis 1: 103–107

    Google Scholar 

  11. Meyer JS, Stoica E, Pascu I, Shimazu K, Hartmann A (1973) Catecholamine concentrations in CSF and plasma of patients with cerebral infarction and haemorrhage. Brain 96: 277–288

    PubMed  Google Scholar 

  12. Middeke M, Klüglich M, Holzgreve H (1991) Circadian blood pressure rhythm in primary and secondary hypertension. Chronobiol Int 8: 451–459

    PubMed  Google Scholar 

  13. Myers MG, Norris JW, Hachinski VC, Sole MJ (1981) Plasma norepinephrine in stroke. Stroke 12: 200–204

    PubMed  Google Scholar 

  14. Norris JW, Froggatt GM, Hachinski VC (1978) Cardiac arrhythmias in acute stroke. Stroke 9: 392–396

    PubMed  Google Scholar 

  15. Oke A, Keller R, Meford I, Adams RN (1978) Lateralization of norepinephrine in human thalamus. Science 200: 1411–1413

    PubMed  Google Scholar 

  16. Oppenheimer SM (1991) The insular cortex and the control of cardiac rythm. Thesis, University of Oxford

  17. Oppenheimer SM, Cechetto DF, Hachinski VC (1990) Cerebrogenic cardiac arrhythmias. Cerebral electrocardiographic influences and their role in sudden death. Arch Neurol 47: 513–519

    PubMed  Google Scholar 

  18. Oppenheimer SM, Wilson JX, Guiraudon C, Cechetto DF (1991) Insular cortex stimulation produces lethal cardiac arrhythmias: a mechanism of sudden death? Brain Res 550:115–121

    PubMed  Google Scholar 

  19. Oppenheimer SM, Gelb A, Girvin JP, Hachinski VC (1992) Cardiovascular effects of human insular cortex stimulation. Neurology 42: 1727–1732

    PubMed  Google Scholar 

  20. Ringelstein EB, Koschorke S, Holling A, Thron A, Lambertz H, Minale C (1989) Computed tomographic patterns of proven embolic brain infarctions. Ann Neurol 26: 759–765

    PubMed  Google Scholar 

  21. Robinson RG (1979) Differential behavioral and biochemical effects of right and left hemispheric cerebral infarction in the rat. Science 205: 707–710

    Google Scholar 

  22. Sander D, Klingelhafer J (1992) Prognostic and therapeutic relevance of circadian blood pressure variations after cerebral infarction. J Neurol 239 [Suppl 3]: 77

    Google Scholar 

  23. Sander D, Klingelhafer J (1994) Changes of circadian blood pressure patterns after hemodynamic and thromboembolic brain infarction. Stroke 25: 1730–1737

    PubMed  Google Scholar 

  24. Silver FL, Norris JW, Lewis AJ, Hachinski VC (1984) Early mortality following stroke: a prospective review. Stroke 15: 492–496

    PubMed  Google Scholar 

  25. Smith KE, Hachinski VC, Gibson CJ, Ciriello J (1986) Changes in plasma catecholamine levels after insula damage in experimental stroke. Brain Res 375:182–185

    PubMed  Google Scholar 

  26. Talairach J, Tournoux P (1988) Coplanar stereotaxic atlas of the human brain. Thieme, Stuttgart

    Google Scholar 

  27. Tuck ML, Stern N, Sowers J (1985) Enhanced 24-hour norepinephrine and renin secretion in young patients with essential hypertension: relation with the circadian pattern of arterial blood pressure. Am J Cardiol 55: 112–115

    PubMed  Google Scholar 

  28. Turton MB, Deegan T (1974) Circadian variations of plasma catecholamine, cortisol and immunoreactive insulin concentrations in supine subjects. Clin Chim Acta 55: 389–397

    PubMed  Google Scholar 

  29. Zamrini EY, Meador KJ, Loring DW, Nichols FT, Lee GP, Figueroa RE, Thompson WO (1990) Unilateral cerebral inactivation produces differential left/right heart rate responses. Neurology 40:1408–1411

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, Technical University of Munich, Möhlstrasse 28, D-81675, Munich, Germany

    Dirk Sander & Jürgen Klingelhöfer

Authors
  1. Dirk Sander
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jürgen Klingelhöfer
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Supported by the Friedrich-Schiedel-Stiftung

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sander, D., Klingelhöfer, J. Changes of circadian blood pressure patterns and cardiovascular parameters indicate lateralization of sympathetic activation following hemispheric brain infarction. J Neurol 242, 313–318 (1995). https://doi.org/10.1007/BF00878874

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00878874

Key words

Search

Navigation