Lateralization hypothesis according to the association between topography of cerebral infarction and autonomic cardiac dysfunction after ischemic stroke
Keywords:
cardiac autonomic regulation, cerebral stroke, cardiac autonomic dysfunction, heart rate variability, insula, lateralization.Abstract
OBJECTIVE: To describe the association between topography of cerebral infarction and the appearance of cardiac autonomic dysfunction after an ischemic stroke.
ACQUISITION OF EVIDENCE: A bibliographic search was conducted in Medline database from 2014 to 2018, using the English terms autonomic heart regulation or autonomic nervous system, ischemic stroke or cerebral infarction, cardiac autonomic dysfunction or heart rate variability (HRV), hypothesis of lateralization, insula, in English and Spanish. The search resulted in 48 original articles and two systematic reviews: a study on the neuroanatomic and physiological basis of cardiovascular autonomic control, three on the evaluation of heart rate variability. In addition 46 articles on the effects of cerebral infarction and its topography on cardiac autonomic function were found.
RESULTS: The insular cortex is considered a center of cardiovascular autonomic integration. Significantly higher values of low frequency / high frequency ratio have been found in patients with right insular infarction. The prominent role of the right insula in the parasympathetic control of cardiac function explains why cerebral infarction in this region can lead to autonomic imbalance and positive regulation of sympathetic function.
CONCLUSIONS: The topography of cerebral infarction is associated with cardiac autonomic dysfunction after an ischemic stroke. Insular infarction is primarily responsible for the majority of autonomic cardiovascular disorders caused by an ischemic stroke. The findings on hemispheric lateralization for autonomic cardiovascular control are contradictory. However, most studies agree that right brain injuries are associated with sympathetic tone increase.
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References
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