Ok Tweeples, we’re going on a #neurotwitter rapid review of tachy/bradyarrhythmias in strokes. A sprinkle of anatomy/physiology, a mini journal club, and chalk talk all wrapped up into one with a tweet to brain time <4.5min (don’t worry, we’ll spare the EVT 😉) 1/
Starting off. We’ve got our central autonomic network comprising of brainstem structures, as well as subcortical & cortical elements including the A&P insula, Inf & Med-F gyrus, Ant cingulate, vent-med prefrontal cortex, and amygdala. 2/
This is known as the heart-brain axis and is illustrated below: 
The insula is important to this pathway. Early murine studies demonstrated laterality in cardiac regulation (right insula for sympathetic control and left insula for parasympathetic control). However, replication in human studies demonstrated mixed results. 4/
Here’s some insula neuroanatomy: pn.bmj.com/content/17/2/1…
Functional mapping of autonomic cardiac responses to insular stimulation in epileptic patients revealed that right and left insular stimulation evoked tachycardia and bradycardia. Interestingly, tachycardias predominated in Posterior Insula and bradycardias in Median Insula 6/
These studies suggest parasympathetic control via R&L median insula and sympathetic control in R&L posterior insula. So we’ve seen these effects in epilepsy, and it is postulated to explain bradycardia and hypotension observed in some seizures. 7/
onlinelibrary.wiley.com/doi/full/10.10…
onlinelibrary.wiley.com/doi/full/10.10…
Is it seen in strokes though? Yes! Strokes involving the insula are commonly associated with bradycardia and 3rd degree AV blocks. Other strokes in this territory display a myriad of arrhythmias ranging from SVT to AF to VT/VF. 8/
A mild troponemia +/- EKG changes are observed commonly in strokes of both hemorrhagic and ischemic origins. While these changes have been associated with worsened mortality in stroke, it is important to rule out cardiac causes first. 9/
Great review article covering this #tweetorial with far more eloquence here: 10/ ahajournals.org/doi/full/10.11…
My first try at a @tony_breu style tweetorial. How'd I do?
@piripiribiryani (OBVIOUSLY she has nothing to do with this)
@threadreaderapp unroll
