Hipótesis de lateralización a partir de la asociación entre la topografÃa del infarto cerebral y la disfunción autonómica cardiaca luego de un ictus isquémico
Resumen
OBJETIVO: Describir la asociación entre la topografÃa del infarto cerebral y la aparición de disfunción autonómica cardÃaca después de un ictus isquémico.
ADQUISICIÓN DE LA EVIDENCIA: Se realizó una búsqueda bibliográfica en la base de datos Medline entre 2014 y 2018, con los términos en inglés: autonomic heart regulation o autonomic nervous system, ischemic stroke o cerebral infarction, cardiac autonomic dysfunction o heart rate variability o HRV, hypothesis of lateralization, insula, y en español. Se encontraron 48 artÃculos originales y dos revisiones sistemáticas. De ellos un estudio sobre las bases neuroanatómicas y fisiológicas del control autonómico cardiovascular, tres sobre evaluación de la variabilidad de la frecuencia cardÃaca, y 46 acerca de los efectos del infarto cerebral y su topografÃa en la función autonómica cardÃaca
RESULTADOS: La corteza insular se considera un centro de integración autonómica cardiovascular. Valores significativamente más altos de la relación de frecuencia baja/frecuencia alta se han encontrado en pacientes con infarto insular derecho. El papel prominente de la Ãnsula derecha en el control parasimpático de la función cardÃaca explica por qué el infarto cerebral de esta región puede conducir a un desequilibrio autonómico y una regulación positiva de la función simpática.
CONCLUSIONES: La topografÃa del infarto cerebral se asocia con la disfunción autonómica cardÃaca luego de un ictus isquémico. El infarto insular es el principal responsable de la mayorÃa de los disturbios autonómicos cardiovasculares provocados por un ictus isquémico. Los hallazgos sobre la lateralización hemisférica para el control autonómico cardiovascular son contradictorios. No obstante, la mayorÃa de los estudios coinciden en que las lesiones cerebrales derechas se asocian con un aumento del tono simpático.
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