wileyonlinelibrary.com/journal/ane Acta Neurol Scand. 2018;138:32–40.
© 2018 John Wiley & Sons A/S.
Published by John Wiley & Sons Ltd
1 | INTRODUCTION
Acute lacunar infarction (ALI) results from the occlusion of small
penetrating arteries that supply the deep brain structure.
patients with ALI experience worsening of their symptoms or pro-
gression of neurologic deficit during hospitalization. This is mostly
due to the enlarging or progression of existing lesions of ALI rather
than the recurrence of new brain lesions. We have referred to the
worsening of symptoms or progression of neurological deficits as
neurological progression in patients with ALI.
Neurological progression is one of the major problems in man-
aging the patients with ALI and is related to the treatment outcome
In the literature, 20% to 30% of ALI patients experi-
enced neurological progression during hospitalization. Neurological
progression usually developed within hours or a few days following
the ALI event and typically involved primarily motor function.
However, the cause or mechanism to explain the neurological pro-
gression in patients with ALI is unclear. We have focused on the
dysfunction of the autonomic nervous system (ANS) as a cause
of neurological progression in patients with ALI. Investigations
Accepted: 1 February 2018
Autonomic function test in progressive lacunar infarction
S. Y. Ha | K. M. Park | J. Park | S. E. Kim | B. I. Lee | K. J. Shin
Department of Neurology, Haeundae-Paik
Hospital, College of Medicine,
Inje University, Busan, Korea
K. J. Shin, Department of Neurology,
Haeundae-Paik Hospital, Inje University,
Objective: Neurological progression is a major problem in managing the patients with
acute lacunar infarction. The purpose of this was to investigate whether autonomic
dysfunction is associated with neurological progression in patients with acute lacu-
Materials and Methods: The study comprised 60 patients with acute lacunar infarc-
tion. All enrolled subjects underwent autonomic function tests including the 30°
head- up tilt test, Valsalva test, heart rate response to deep breathing, and sympa-
thetic skin response. The primary endpoint is the neurological progression, and the
secondary endpoint is the 3- month outcome.
Results: Increased initial National Institute of Health stroke scale (NIHSS), decreased
time to admission from onset, decreased rise of heart rate in the 30° head- up tilt test,
abnormal blood pressure response in the Valsalva test, and decreased rise of systolic
blood pressure in stage IV of the Valsalva test are associated with neurological pro-
gression of acute lacunar infarction; an abnormal blood pressure response in the
Valsalva test is significant in logistic regression analysis of neurological progression.
Advanced age, increased initial NIHSS and modified Rankin scale, decreased expira-
tion/inspiration ratio of heart rate to deep breathing, decreased rise of systolic blood
pressure in stage IV of the Valsalva test, and neurological progression were associ-
ated with an unfavorable 3- month outcome; neurological progression was significant
in logistic regression analysis of 3- month outcome.
Conclusions: An abnormal blood pressure change in the Valsalva test is associated
with neurological progression in patients with acute lacunar infarction, and neuro-
logical progression can induce an unfavorable 3- month outcome.
autonomic dysfunction, head-up tilt test, lacunar infarcts, neurological progression, outcome,