Benign Paroxysmal Positional Vertigo can Interfere with the Cardiac Response to Head-Down Tilt

Jáuregui‐Renaud, Kathrine; Aw, Swee T.; Todd, Michael J.; McGarvie, Leigh A.; Halmagyi, G. Michael

doi:10.1097/01.mao.0000169783.76964.f6

Cited by 8 publications

(11 citation statements)

References 18 publications

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“…A series of studies by Jauregui-Renaud and colleagues examined cardiovascular responses in cohorts of patients with acute vertigo (158), benign paroxysmal positional vertigo (BPPV) (157) or chronic bilateral idiopathic loss of vestibular function (159). In the first of these studies (158), the heart rate, systolic and diastolic blood pressures and the power spectrum of heart rate variability of seven patients were examined within 72 hours of developing vertigo involving unilateral peripheral vestibular failure due to acute vestibular neuritis.…”

Section: Vestibulosympathetic Reflexes Evoked By Natural Stimulation mentioning

confidence: 99%

“…In the second study, Jauregui-Renauld et al (157) examined patients with benign paroxysmal positional vertigo (BPPV), which involves dysfunction of the semicircular canal system due to the normal mechanical dynamics of the canal system being altered by displaced otoconia. The study compared cardiovascular parameters in patients with unilateral (n=3) or bilateral (n=1) BPPV and healthy (n=9) subjects.…”

Section: Vestibulosympathetic Reflexes Evoked By Natural Stimulation mentioning

confidence: 99%

“…However, some studies reported that changes in heart rate (157, 158, 234, 235, 315) and heart rate variability (158) normally exhibited in vestibular intact persons are compromised or lost in persons with vestibular dysfunction, suggesting the vestibular system plays a role in cardiovascular regulation in the human. While these studies suggest that the peripheral otolith organs (8, 10, 11, 159, 234, 235, 315) and semicircular canals (234, 235) may be involved, it is difficult to draw conclusions regarding the mechanism(s) or role(s) of the vestibular system in cardiovascular regulation from these few heterogeneous clinical cohort studies.…”

Section: Vestibulosympathetic Reflexes Evoked By Natural Stimulation mentioning

confidence: 99%

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Vestibulo‐Sympathetic Responses

Yates

Bolton

Macefield

2014

Comprehensive Physiology

144

130

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Evidence accumulated over 30 years, from experiments on animals and human subjects, has conclusively demonstrated that inputs from the vestibular otolith organs contribute to the control of blood pressure during movement and changes in posture. This review considers the effects of gravity on the body axis, and the consequences of postural changes on blood distribution in the body. It then separately considers findings collected in experiments on animals and human subjects demonstrating that the vestibular system regulates blood distribution in the body during movement. Vestibulosympathetic reflexes differ from responses triggered by unloading of cardiovascular receptors such as baroreceptors and cardiopulmonary receptors, as they can be elicited before a change in blood distribution occurs in the body. Dissimilarities in the expression of vestibulosympathetic reflexes in humans and animals are also described. In particular, there is evidence from experiments in animals, but not humans, that vestibulosympathetic reflexes are patterned, and differ between body regions. Results from neurophysiological and neuroanatomical studies in animals are discussed that identify the neurons that mediate vestibulosympathetic responses, which include cells in the caudal aspect of the vestibular nucleus complex, interneurons in the lateral medullary reticular formation, and bulbospinal neurons in the rostral ventrolateral medulla (RVLM). Recent findings showing that cognition can modify the gain of vestibulosympathetic responses are also presented, and neural pathways that could mediate adaptive plasticity in the responses are proposed, including connections of the posterior cerebellar vermis with the vestibular nuclei and brainstem nuclei that regulate blood pressure.

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Section: Vestibulosympathetic Reflexes Evoked By Natural Stimulation mentioning

confidence: 99%

Section: Vestibulosympathetic Reflexes Evoked By Natural Stimulation mentioning

confidence: 99%

Section: Vestibulosympathetic Reflexes Evoked By Natural Stimulation mentioning

confidence: 99%

See 1 more Smart Citation

Vestibulo‐Sympathetic Responses

Yates

Bolton

Macefield

2014

Comprehensive Physiology

144

130

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“…A better understanding of involved mechanisms may be obtained by analysing data from human experimentation in physiological study on body responses to head-down tilt (HDT). In Table 2, results from several human experimental studies with HDT of more than 30°are compiled [10][11][12][13][14][15][16][17][18][19][20][21][22]. According to these results, it seems that cardiac output is significantly increased after HDT, mainly by an increase in stroke volume.…”

Section: Discussionmentioning

confidence: 81%

“…Besides, the oxygen saturation and the pressure of carbon dioxide (pCO 2 ) stayed stable during those experimental HDT. It should be mentioned, however, that very few studies have focussed on this issue of blood gas saturation [15,18,20]. Nevertheless, death by head-down position seems to be more related to a heart failure secondary to the increased burden of work for the heart than to an asphyxial phenomenon per se.…”

Section: Discussionmentioning

confidence: 90%

Deaths in a head-down position: a case report and review of the literature

Sauvageau¹,

Desjarlais²,

Racette³

2007

Forensic Sci Med Pathol

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Deaths in a head-down position, mostly accidental events, are rare deaths in which a victim is found in an inverted body posture, with marked congestion of dependent body parts and no definite pathoanatomical cause of death. Such an exclusion diagnosis can only be put forward after elimination of other possible causes of death, following a scene investigation, medical record review, complete autopsy, and toxicological analysis. Particular attention should be taken not to confuse deaths by head-down position from the more usual positional asphyxia. We here report the case of an 82-year-old woman found stuck in the railings of the staircase leading to her house, her body freely suspended downward below the stairs. Death was finally attributed to a head-down position when correlating the autopsy findings with elements from the scene. Case reports of death by head-down position in the literature are reviewed. Furthermore, results from human experimental studies of head-down tilt are compiled. This systematic review allows an interesting insight into the physiopathology of those deaths, pointing more toward heart failure than to an asphyxial phenomenon per se.

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