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Effects of Stroke on the Autonomic Nervous System

Anne M. Dorrance, Greg Fink

10.1002/cphy.c140016

Source: Volume 5, Issue 3, July 2015

Published online: June 2015

Full Article on Wiley Online Library



ABSTRACT

Stroke is the fourth leading cause of death in the United States and the second most common cause of death worldwide; stroke is also the leading cause of long‐term disability worldwide. It is clear that the consequences of cerebral ischemia reach beyond the brain into the periphery, and a significant number of stroke related deaths are the result of conditions that develop poststroke in the periphery. The two leading causes of non‐neurogenic death poststroke are cardiac abnormalities and infections. Changes in autonomic nervous system function that favor increased sympathetic nervous system activity and reduced parasympathetic nervous system activity appear to be causative factors in both conditions. Here, we review the evidence that sympathetic nervous system activity increases and parasympathetic nervous system activity declines poststroke. We discuss effects of autonomic dysfunction on cardiac arrhythmias and heart rate variability. Finally, we discuss the evidence supporting a role for autonomic dysfunction in the increased incidence of infection poststroke. Although the death rate from stroke is declining in the United States, the incidence of stroke is not. With more patients surviving the initial ischemic event it is important that we broaden our understanding of the chronic effects of stroke on the human condition. © 2015 American Physiological Society. Compr Physiol 5:1241‐1263, 2015.

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Figure 1. Figure 1. Frequency distribution of numbers of deaths and cause of death per week from stroke onset; weeks 7 to 12 have been compressed because of low absolute numbers. Figure used, with permission, from (166).
Figure 2. Figure 2. (Panel A) Schematic representation of the of the perivascular nerves. The extrinsic nerves to the cerebral blood vessels on the brains surface arise from the peripheral nervous system (PNS) and originate from the superior cervical (SCG), sphenopalatine (SPG), or otic (OG) or trigeminal (TG) ganglion. Blood vessels located within the brain parenchyma are innervated by intrinsic nerve pathways from the central nervous system (CNS). Cortical microvessels receive NE, 5‐HT, Ach, or GABAergic afferents from either subcortical neurons from the locus coeruleus, raphe nucleus, basal forebrain, or local cortical interneurons. Inset: the neurovascular unit, with the vascular [endothelium (medium gray) and smooth muscle or pericyte (dark gray)], astroglial (light gray), and neuronal (axon varicosities are highlighted) compartments. (Panel B) The regulation of cortical microvessels from cells located in subcortical areas and within the cerebral cortex. The known or suggested vasoactive mediators and the vascular receptors on which neuronal or astroglial signaling molecules are believed to act to induce dilatation or constriction are illustrated. ACh, acetylcholine; CGRP, calcitonin gene‐related peptide; GABA, γ‐aminobutyric acid; NA, norepinephrine; NKA, neurokinin A; NOS, nitric oxide synthase; NPY, neuropeptide Y; PACAP, pituitary adenylate‐cyclase activating polypeptide; SOM, somatostatin; SP, substance P; VIP, vasoactive intestinal polypeptide; 5‐HT, serotonin. Images used, with permission, from Hamel (78).
Figure 3. Figure 3. Schematic representation of the potential effects of stroke on cardiac function. SNS, sympathetic nervous system: PNS, parasympathetic nervous system; ROS, reactive oxygen species; HRV, heart‐rate variability.
Figure 4. Figure 4. Schematic representation of the potential effects of stroke on the immune system. Information presented in the blue boxes represents the anti‐inflammatory effects of stroke; the information depicted in the red box depicts the proinflammatory effects of stroke. The information in the green box depicts the situation in the bone marrow and it is as yet unclear if these effects are pro‐ or anti‐inflammatory. SNS, sympathetic nervous system: PNS, parasympathetic nervous system; TNF‐α, tumor necrosis factor alpha; IL‐10, interleukin 10; iNKT, invariant natural killer T cells, IFN‐γ, interferon gamma; MCP‐1, monocyte chemoattractant protein 1.


Figure 1. Frequency distribution of numbers of deaths and cause of death per week from stroke onset; weeks 7 to 12 have been compressed because of low absolute numbers. Figure used, with permission, from (166).


Figure 2. (Panel A) Schematic representation of the of the perivascular nerves. The extrinsic nerves to the cerebral blood vessels on the brains surface arise from the peripheral nervous system (PNS) and originate from the superior cervical (SCG), sphenopalatine (SPG), or otic (OG) or trigeminal (TG) ganglion. Blood vessels located within the brain parenchyma are innervated by intrinsic nerve pathways from the central nervous system (CNS). Cortical microvessels receive NE, 5‐HT, Ach, or GABAergic afferents from either subcortical neurons from the locus coeruleus, raphe nucleus, basal forebrain, or local cortical interneurons. Inset: the neurovascular unit, with the vascular [endothelium (medium gray) and smooth muscle or pericyte (dark gray)], astroglial (light gray), and neuronal (axon varicosities are highlighted) compartments. (Panel B) The regulation of cortical microvessels from cells located in subcortical areas and within the cerebral cortex. The known or suggested vasoactive mediators and the vascular receptors on which neuronal or astroglial signaling molecules are believed to act to induce dilatation or constriction are illustrated. ACh, acetylcholine; CGRP, calcitonin gene‐related peptide; GABA, γ‐aminobutyric acid; NA, norepinephrine; NKA, neurokinin A; NOS, nitric oxide synthase; NPY, neuropeptide Y; PACAP, pituitary adenylate‐cyclase activating polypeptide; SOM, somatostatin; SP, substance P; VIP, vasoactive intestinal polypeptide; 5‐HT, serotonin. Images used, with permission, from Hamel (78).


Figure 3. Schematic representation of the potential effects of stroke on cardiac function. SNS, sympathetic nervous system: PNS, parasympathetic nervous system; ROS, reactive oxygen species; HRV, heart‐rate variability.


Figure 4. Schematic representation of the potential effects of stroke on the immune system. Information presented in the blue boxes represents the anti‐inflammatory effects of stroke; the information depicted in the red box depicts the proinflammatory effects of stroke. The information in the green box depicts the situation in the bone marrow and it is as yet unclear if these effects are pro‐ or anti‐inflammatory. SNS, sympathetic nervous system: PNS, parasympathetic nervous system; TNF‐α, tumor necrosis factor alpha; IL‐10, interleukin 10; iNKT, invariant natural killer T cells, IFN‐γ, interferon gamma; MCP‐1, monocyte chemoattractant protein 1.
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Article Title: Effects of Stroke on the Autonomic Nervous System
 

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Anne M. Dorrance, Greg Fink. Effects of Stroke on the Autonomic Nervous System. Compr Physiol 2015, 5: 1241-1263. doi: 10.1002/cphy.c140016