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Insular stroke is associated with acute sympathetic hyperactivation and immunodepression
European Journal of Neurology, 08/01/2012
Clinical Article
Walter U et al. – The findings suggest a specific role of insular lesion in the pathogenesis of stroke–induced sympathetic hyperactivation and immunodepression. Neuroimaging studies applying lesion volume calculation techniques are warranted to confirm these findings.
Methods- The authors analyzed clinical, brain imaging, and laboratory data of 384 patients (174 women; mean age 70.8 ± 12.9 years) consecutively admitted to the stroke unit no later than 24 h after onset of acute ischaemic stroke involving the MCA territory.
- Patients with lesion affecting >33% of MCA territory had increased serum metanephrine and normetanephrine levels, elevated neutrophil counts but decreased eosinophil, helper T lymphocyte, and cytotoxic T lymphocyte counts compared to patients with lesion in <33% of MCA territory.
- Patients with large infarctions had increased frequency of infections within 14 days after stroke, especially chest infections (P<0.001).
- Considering only patients with non-lacunar infarction in <33% of MCA territory, those with insular lesion had significantly higher normetanephrine levels, higher neutrophil but lower eosinophil and helper T lymphocyte counts than those with non-insular lesion, despite similar lesion diameters.
- This coincided with an increased frequency of chest infections (P<0.01) in patients with insular lesion.
- Whilst patients with right insular lesion showed decreased heart rate variability, lesion laterality had no impact on laboratory findings or infection frequency.