Prognostic value of the stress response following stroke.

The systemic metabolic response following intracranial vascular damage was measured in 65 consecutively seen patients (56 with cerebral infarction and nine with subarachnoid hemorrhage). Significantly (P less than .01) greater mortality and eventual disability occurred in patients excreting more than 200 microgram of urinary norepinephrine and epinephrine daily early in their acute illness. These patients also had significantly (P less than .001) elevated plasma cortisol levels; this measurement may prove useful in predicting prognosis after stroke. Cardiac abnormalities resulting from the elevated catecholamine levels may contribute to the excess mortality in those patients with an intense stress response.