Autonomic dysfunction is one of the predictors of poor outcome in patients with acute ischemic stroke. We compared the heart rate variability (HRV) during early mobilization in patients with or without neurological deterioration (ND). We enrolled 7 acute ischemic patients with ND and 14 without ND and measured their HRV in the rest and mobilization by electrocardiography. There was a significant difference in sympathetic nervous activity during mobilization between the 2 groups. However, no significant differences in blood pressure, heart rate, and parasympathetic nerve activity were observed. In patients with acute ischemic stroke, it is likely that the increase in sympathetic nervous activity during mobilization is associated with ND.

Keywords:
Acute stroke treatment, Autonomic nervous system, Ischemic stroke
1.
Kwan J, Hand P: Early neurological deterioration in acute stroke: clinical characteristics and impact on outcome. QJM 2006; 99: 625–633.
2.
Nacu A, Bringeland GH, Khanevski A, Thomassen L, Waje-Andreassen U, Naess H: Early neurological worsening in acute ischaemic stroke patients. Acta Neurol Scand 2016; 133: 25–29.
3.
Geng HH, Wang Q, Li B, Cui BB, Jin YP, Fu RL, Zhang Q, Wang JJ, Wang PX: Early neurological deterioration during the acute phase as a predictor of long-term outcome after first-ever ischemic stroke. Medicine (Baltimore) 2017; 96:e9068.
4.
Thanvi B, Treadwell S, Robinson T. Early neurological deterioration in acute ischaemic stroke: predictors, mechanisms and management. Postgrad Med J 2008; 84: 412–417.
5.
Toyoda K, Fujimoto S, Kamouchi M, Iida M, Okada Y: Acute blood pressure levels and neurological deterioration in different subtypes of ischemic stroke. Stroke 2009; 40: 2585–2588.
6.
Ogata T, Yasaka M, Wakugawa Y, Ibayashi S, Okada Y: Predisposing factors for acute deterioration of minor ischemic stroke. J Neurol Sci 2009; 287: 147–150.
7.
Audebert HJ, Pellkofer TS, Wimmer ML, Haberl RL: Progression in lacunar stroke is related to elevated acute phase parameters. Eur Neurol 2004; 51: 125–131.
8.
Bernhardt J, Langhorne P, Lindley RI, et al: Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial. Lancet 2015; 386: 46–55.
9.
Olavarría VV, Arima H, Anderson CS, et al: Head position and cerebral blood flow velocity in acute ischemic stroke: a systematic review and meta-analysis. Cerebrovasc Dis 2014; 37: 401–408.
10.
Chippala P, Sharma R: Effect of very early mobilisation on functional status in patients with acute stroke: a single-blind, randomized controlled trail. Clin Rehabil 2016; 30: 669–675.
11.
Li Z, Zhang X, Wang K, Wen J: Effects of early mobilization after acute stroke: a meta-analysis of randomized control trials. J Stroke Cerebrovasc Dis 2018; 27: 1326–1337.
12.
Xu T, Yu X, Ou S, Liu X, Yuan J, Chen Y: Efficacy and safety of very early mobilization in patients with acute stroke: a systematic review and meta-analysis. Sci Rep 2017; 7: 6550.
13.
Chen PL, Kuo TB, Yang CC: Parasympathetic activity correlates with early outcome in patients with large artery atherosclerotic stroke. J Neurol Sci 2012; 314: 57–61.
14.
Xiong L, Leung H, Chen XY, Han JH, Leung T, Soo Y, Wong E, Chan A, Lau A, Wong KS: Preliminary findings of the effects of autonomic dysfunction on functional outcome after acute ischemic stroke. Clin Neurol Neurosurg 2012; 114: 316–320.
15.
Nayani S, Sreedharan SE, Namboodiri N, Sarma PS, Sylaja PN: Autonomic dysfunction in first ever ischemic stroke: prevalence, predictors and short term neurovascular outcome. Clin Neurol Neurosurg 2016; 150: 54–58.
16.
Xiong L, Tian G, Leung H, Soo YOY, Chen X, Ip VHL, Mok VCT, Chu WCW, Wong KS, Leung TW: Autonomic dysfunction predicts clinical outcomes after acute ischemic atroke: a prospective observational study. Stroke 2018; 49: 215–218.
17.
Immink RV, van Montfrans GA, Stam J, Karemaker JM, Diamant M, van Lieshout JJ: Dynamic cerebral autoregulation in acute lacunar and middle cerebral artery territory ischemic stroke. Stroke 2005; 36: 2595–2600.
18.
Watanabe M, Tomiyama-Miyaji C, Kainuma E, Inoue M, Kuwano Y, Ren H, Shen J, Abo T: Role of alpha-adrenergic stimulus in stress-induced modulation of body temperature, blood glucose and innate immunity. Immunol Lett 2008; 115: 43–49.
19.
Kanai M, Kubo H, Kitamura Y, Izawa KP, Ono K, Ando H, Nozoe M, Mase K, Shimada S: Difference in autonomic nervous activity in different subtypes of noncardioembolic ischemic stroke. Int J Cardiol 2015; 201: 171–173.
20.
Usui H, Nishida Y: Relationship between physical activity and the very low-frequency component of heart rate variability after stroke. J Stroke Cerebrovasc Dis 2015; 24: 840–843.
21.
Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task force of the European society of cardiology and the North American society of pacing and electrophysiology. Eur Heart J 1996; 17: 354–381.
22.
Asdaghi N, Jeerakathil T, Hameed B, Saini M, McCombe JA, Shuaib A, Emery D, Butcher K: Oxfordshire community stroke project classification poorly differentiates small cortical and subcortical infarcts. Stroke 2011; 42: 2143–2148.
23.
Siegler JE, Boehme AK, Kumar AD, Gillette MA, Albright KC, Martin-Schild S: What change in the National Institutes of Health Stroke Scale should define neurologic deterioration in acute ischemic stroke? J Stroke Cerebrovasc Dis 2013; 22: 675–682.
24.
Hilz MJ, Moeller S, Akhundova A, Marthol H, Pauli E, De Fina P, Schwab S: High NIHSS values predict impairment of cardiovascular autonomic control. Stroke 2011; 42: 1528–1533.
25.
Sethi A, Callaway CW, Sejdić E, Terhorst L, Skidmore ER: Heart rate variability is associated with motor outcome 3-months after stroke. J Stroke Cerebrovasc Dis 2016; 25: 129–135.
26.
Perini R, Veicsteinas A: Heart rate variability and autonomic activity at rest and during exercise in various physiological conditions. Eur J Appl Physiol 2003; 90: 317–325.
27.
Watanabe N, Reece J, Polus BI: Effects of body position on autonomic regulation of cardiovascular function in young, healthy adults. Chiropr Osteopat 2007; 15: 19.
28.
Alexandrov AW, Tsivgoulis G, Hill MD, -Liebeskind DS, Schellinger P, Ovbiagele B, Arthur AS, Caso V, Nogueira RG, Hemphill JC 3rd, Grotta JC, Hacke W, Alexandrov AV: HeadPoST: rightly positioned, or flat out wrong? Neurology 2018; 90: 885–889.
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2018
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