Manifestation Of Sympathetic Skin Response And Study On Its Clinical Correlation In Person With Acute Ischemic Cerebrovascular Disease

Objective We utilize sympathetic skin response( SSR) in patients with acute ischemic cerebrovascular disease( AICVD) in the study, aiming to achieve the objectives as follows. 1. To know the the anormal patterns of SSR in patients with AICVD and its correlation with clinical presentation of patients; 2. To explore the characteristics of SSR during acute stage of ischemic cerebrovascular disease and the regulatory mechanisms of SSR;3. To assess the value of SSR in detecting dysfunction of autonomic nervous system and evaluating long-term prognosis in patients with AICVD.Methods SSR of the upper limbs was performed in 30 healthy subjects and 66 patients with AICVD(including 46 acute ischemic stroke(AIS)patients and 20 Transient ischemic attack(TIA)patients; three subgroups namely cortical-subcortical, thalamus-internal capsule-basal ganglia, brain stem-cerebellum were further subdivided in the AIS group according to neuroimaging) after they entered hospital, as well as grading of the National Institute of Health stroke scale(NIHSS), Barthel index(BI)and Recurrent risk(ABCD2/ESRS), and imaging examination.Recording all results above and the data analyzed statistically.Results1) Compared with the control group, the SSR of upper limbs in AICVD patients mainly show prolonged latency, reduced amplitude, and disappeared waveform. There is no statistical difference in latency and amplitude of SSR between the affected side and the healthy side. 2)In the case group, there reveals no statistical difference between AIS group and TIA group in SSR latencies and amplitudes. 3) In the AIS group, the abnormality rate of SSR in cortical-subcortical subgroup is the highest,then followed the thalamus-internal capsule-basal ganglia subgroup and brainstem-cerebellum subgroup, however, no significant difference was showed among the three. In these three subgroups, SSR latency of the upper limbs in both healthy and affected sides are longer than that in the control group; group; Neither significant difference were found in SSR latency and amplitude of the both sides within any subgroup nor among the three subgroups. 4)There represents a correlation between the abnormality rate of SSR and the clinical manifestation of AICVD patients.Firstly, a positive correlation is discovered between the total abnormality rate of SSR and the NIHSS, as well as the Recurrence risk score; while a negative correlation is revealed between the total abnormality rate of SSR and the BI. Secondly, the prolonged SSR latency is positively related to the NIHSS and the Recurrence risk score, and negatively related to the BI.Thirdly, the decreased amplitude is positively related to the NIHSS and negatively related to the BI. Lastly, the disappeared waveform is positively related to the Recurrence risk score.Conclusions1) SSR in AICVD patients mainly manifest as extended latency,decreased amplitude, and missed waveform, which indicates there is a inhibition in sympathetic reflex activity among AICVD patients.2)No significant difference was found between the AIS group and the TIA group may suggest the inhibition in function of sympathetic nervous system after acute cerebral ischemia may be independent of the degree of ischemia itself.3)In the AIS group, SSR abnormal rate in cortico-subcortical subgroup is the highest, then followed by thalamus-internal capsule-basal ganglia subgroup and the brainstem-cerebellum subgroup in turn; however, no significant difference was finally found, which agree with the previous theory that sympathetic nervous system is regulated by the cortex-cerebral ganglia-brainstem routine.4)The prolonged SSR latency is positively related to the NIHSS and the Recurrence Score, and negatively related to the BI; the decreased amplitude is positively related to the NIHSS and negatively related to the BI; the missed waveform is positively related to the Recurrence risk score.5)SSR might be used to quantitatively evaluate the state of sympathetic nerve function, and might be of diagnostic value in the subclinical autonomic nerve dysfunction.