Autonomic dysfunction and treatment strategies in intracerebral hemorrhage

Author:

Kang Kaijiang123ORCID,Shi Kaibin123ORCID,Liu Jiexin123,Li Na123,Wu Jianwei123,Zhao Xingquan1234ORCID

Affiliation:

1. Department of Neurology Beijing Tiantan Hospital Capital Medical University Beijing China

2. China National Clinical Research Center for Neurological Diseases Beijing China

3. Center of Stroke Beijing Institute for Brain Disorders Beijing China

4. Research Unit of Artificial Intelligence in Cerebrovascular Disease Chinese Academy of Medical Sciences Beijing China

Abstract

AbstractAimsAutonomic dysfunction with central autonomic network (CAN) damage occurs frequently after intracerebral hemorrhage (ICH) and contributes to a series of adverse outcomes. This review aims to provide insight and convenience for future clinical practice and research on autonomic dysfunction in ICH patients.DiscussionWe summarize the autonomic dysfunction in ICH from the aspects of potential mechanisms, clinical significance, assessment, and treatment strategies. The CAN structures mainly include insular cortex, anterior cingulate cortex, amygdala, hypothalamus, nucleus of the solitary tract, ventrolateral medulla, dorsal motor nucleus of the vagus, nucleus ambiguus, parabrachial nucleus, and periaqueductal gray. Autonomic dysfunction after ICH is closely associated with neurological functional outcomes, cardiac complications, blood pressure fluctuation, immunosuppression and infection, thermoregulatory dysfunction, hyperglycemia, digestive dysfunction, and urogenital disturbances. Heart rate variability, baroreflex sensitivity, skin sympathetic nerve activity, sympathetic skin response, and plasma catecholamine concentration can be used to assess the autonomic functional activities after ICH. Risk stratification of patients according to autonomic functional activities, and development of intervention approaches based on the restoration of sympathetic‐parasympathetic balance, would potentially improve clinical outcomes in ICH patients.ConclusionThe review systematically summarizes the evidence of autonomic dysfunction and its association with clinical outcomes in ICH patients, proposing that targeting autonomic dysfunction could be potentially investigated to improve the clinical outcomes.

Funder

National Key Research and Development Program of China

Publisher

Wiley

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