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Insular stroke is associated with acute sympathetic hyperactivation and immunodepression
U Walter1, S Kolbaske, R Patejdl
1Department of Neurology, University of Rostock, Rostock, Germany. uwe.walter@med.uni-rostock.de
European Journal of Neurology
|July 28, 2012
Summary
Stroke lesions in the insula region, not just size, trigger sympathetic nervous system overactivation and immune suppression, increasing infection risk. This highlights the insula's specific role in post-stroke complications.
Area of Science:
- Neurology
- Immunology
- Neuroscience
Background:
- Post-stroke immunodepression is linked to lesion size but not specific locations.
- The middle cerebral artery (MCA) territory is a common site for ischemic stroke.
Purpose of the Study:
- To investigate how lesion location within the MCA territory influences sympathetic nervous system activation, immunodepression, and infection risk.
- To determine if specific brain regions, like the insula, play a distinct role in these post-stroke effects.
Main Methods:
- Analysis of clinical, neuroimaging, and laboratory data from 384 acute ischemic stroke patients within the MCA territory.
- Comparison of immune markers, sympathetic activity indicators, and infection rates based on lesion size and location (insular vs. non-insular).
Main Results:
- Larger MCA territory lesions (>33%) correlated with increased metanephrine/normetanephrine, neutrophils, and infection rates, alongside decreased eosinophils and T lymphocytes.
- Insular lesions, even non-lacunar ones <33% MCA territory, showed higher normetanephrine, neutrophils, and chest infection rates, with lower eosinophils and helper T cells compared to non-insular lesions.
- Right insular lesions were associated with reduced heart rate variability, but lesion laterality did not affect lab findings or infection frequency.
Conclusions:
- Insular lesions specifically contribute to stroke-induced sympathetic hyperactivation and immunodepression.
- These findings suggest a targeted role for the insula in post-stroke immune dysregulation and infection susceptibility.
- Further neuroimaging studies with precise lesion volume calculations are recommended to validate these results.
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