Mechanisms of brain-body interactions in post-stroke visceral dysfunction and recovery.

Abstract

Traditionally, stroke has been characterized as an acute focal brain injury; however, its clinical consequences extend beyond neurological deficits to encompass visceral dysfunction, which substantially influences functional outcomes, quality of life, and social reintegration. Here, we advance an integrated brain-body interaction (BBI) framework that conceptualizes post-stroke visceral dysfunction as a systemic consequence of disrupted communication between the brain and peripheral organs, rather than as isolated organ-specific complications. This review synthesizes four interconnected pathways involved in this process: autonomic regulation, neuroimmune interactions, neurohumoral signalling, and the microbiota-gut-brain axis (MGBA). Additionally, we examine emerging interventions aimed at restoring visceral function through recalibration of brain-body signalling, including neural plasticity enhancement, vagus nerve stimulation (VNS), acupuncture, and microbiota-based modulation. By linking shared mechanisms to multimodal therapeutic targets, this perspective supports a transition from organ-specific complication management to systems-level, mechanism-guided rehabilitation. Although clinical evidence remains heterogeneous, future progress will require long-term physiological monitoring, multimodal imaging, multi-omics, and artificial intelligence-enabled analyses to advance clinical diagnosis and precision rehabilitation within a systems-neuroscience framework.