Cerebral ischemia may increase extracellular choline concentration by interfering with its removal by the circulation and by enhancing its net production from phospholipids.

Focal ischemia enhances choline output and decreases acetylcholine output from rat cerebral cortex

OU Scremin and DJ Jenden
Veterans Administration Medical Center, Albuquerque, New Mexico 87108.

Stroke, Vol 20, 92-95, Copyright © 1989 by American Heart Association

Mia: these changes are present in post-sympathectomy patients as well, providing further proof on cerebral ischemia (Brain MRI) that causes the cognitive function changes in many patients who undergo the surgery.