Acute Autonomic Instability

  • Derk Krieger
  • Shreyas V. Patel
  • Daniel F. Hanley


This chapter concerns acute autonomic instability in neurologic diseases affecting the anatomic integrity of central and peripheral autonomic control loops. In particular, cardiovascular and respiratory dysfunction may act as life-threatening complications during neurocritical care treatment and deserve further discussion. The autonomic nervous system orchestrates a wide range of vegetative functions via either the sympathetic nervous system or the parasympathetic system, or both. Furthermore, there is evidence for diffuse interaction between the autonomic and endocrine systems. Thus cardiovascular and pulmonary function, electrolyte-fluid balance, and adaptation to variable demands contribute to the integrity of autonomic control mechanisms. Responses of peripheral end-organs are determined by transmitter release; catecholamines at the sympathetic nerve ending, acetylcholine at the parasympathetic neuron effector junction, and addi-tional humoral contribution of circulating epinephrine and norepinephrine from the adrenal medulla. Over-activity of the sympathetic limb of the autonomic system is thought to be the phenomenon that links cardiac and pulmonary pathology found in acute central nervous accidents. Profound effects on the heart and the lungs may contribute to the death rates of many primary neurologic conditions such as subarachnoid hemorrhage, stroke, status epilepticus, and head trauma. The cardiovascular system plays a pivotal role in homeostasis by adjusting the blood supply to various vascular beds in proportion to their level of activity. The maintenance of arterial pressure and the regulation of cardiac output in the face of different behavioral demands can be achieved by integration of peripheral reflex inputs and central drives at the level of the brain stem. Additionally, the autonomic nervous system affects cardiovascular function through influences on electrolyte and fluid balance and hormonal mechanisms. Cardiorespiratory interactions involve a complex and still unresolved integration at different sites of the nervous system; however, they may play a crucial role in explaining respiratory arrest or fatal cardiac arrhythmia in neurologic disease.


Pulmonary Edema Respiratory Rhythm Neurogenic Pulmonary Edema Subarachnoid Hemor Lateral Medulla 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Springer-Verlag Berlin Heidelberg 1994

Authors and Affiliations

  • Derk Krieger
  • Shreyas V. Patel
  • Daniel F. Hanley

There are no affiliations available

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