Uncontrolled Blood Pressure In Chronic Stroke, Right Insular ICH : A Case Report

초록

Introduction <br>Autonomic dysfunction after a stroke involves the cardiovascular and respiratory systems. The present study was undertaken to study autonomic reflexes reflecting parasympathetic and sympathetic influence on heart rate and blood pressure in patients with monofocal stroke to determine whether such reflexes are affected differently depending on the side of the lesion. For the past two decades, there has been an increased interest in studying the association of autonomic function alteration with hemispheric stroke locations, including the insular cortex and the frontal and parietal lobes. <br> <br>Case <br>A 49 year old man with chronic stroke referred to ER with loss of consciousness. He had medical history of the previous right basal insular hemorrhage, 2 years ago. There was no seizure like movement and neurologic symptoms about cerebrovascular accident. Brain CT reveal that no acute lesion and encephalomalacia in right insular. So he was admitted to a cardiology department for evaluation. He presented with dizziness and fluctuation of blood pressure at sitting or standing position(systolic pressure 50~200). There was no problem in TTE, holter, 24 h ambulatory BP monitoring. For management of general weakness, he was transferred to department of rehabilitation medicine. After few days, his muscle power was improved but still had fluctuation of blood pressure and dizziness. We suspected the autonomic dysfunction and orthostatic hypotension, so performed the study of autonomic dysfunction. The charts below show the result. <br> Figure1. Blood pressure fluctuation <br> Table1. Respiratory Heart Rate Variability <br> Table2. Tilt table test <br>These findings were compatible with autonomic dysfunction and orthostatic hypotension. After the patient was taken the fludrocortisone, fluctuation of blood pressure was improved but still remained(systolic pressure 80~160). <br>Conclusion <br>With unusual case, We report the case about Autonomic dysfunction in ch