Associations between ischemic stroke location and autonomic-cardiovascular disturbances: A scoping review

Autonomic and cardiovascular disturbances are common after ischemic stroke and contribute to morbidity and mortality. Disruption of the cortical autonomic network has been proposed as a mechanistic link between cerebral injury and cardiac dysfunction, yet the relationship between ischemic stroke location and autonomic-cardiovascular outcomes has not been comprehensively mapped.

We conducted a scoping review following Joanna Briggs Institute methodology. MEDLINE, EMBASE, and CENTRAL were searched from inception to December 9, 2025, for studies evaluating adult ischemic stroke patients that reported lesion location and autonomic-cardiovascular outcomes. Data were independently extracted by two reviewers, with disagreements resolved by a third reviewer. Results were synthesized qualitatively.

Forty-one studies comprising 10,950 patients were included. Among studies evaluating hemispheric effects, 13/17 reported that right-sided ischemic strokes were associated with greater autonomic impairment compared to left-sided strokes, including reduced heart rate variability, sympathetic predominance, higher catecholamine levels, arrhythmias, and early mortality. Similarly, 17/22 studies examining insular involvement demonstrated associations with adverse cardiovascular-autonomic markers, including reduced heart rate variability, impaired baroreflex sensitivity, QT prolongation, arrhythmias, elevated cardiac biomarkers, and increased short-term mortality. Parietal cortex, basal ganglia, thalamus, and brainstem regions were also implicated in autonomic dysregulation.

Evidence suggests that ischemic stroke location and hemispheric laterality are associated with autonomic-cardiovascular disturbances, particularly when the insula and broader cortical autonomic network are involved. Patterns support a network-based neurocardiac mechanism rather than a single locus. Future studies integrating high-resolution lesion mapping with standardized autonomic/cardiac assessments are needed to clarify mechanisms and inform targeted monitoring and intervention.