Brain Perfusion Assessed by 99mTc‐ECD SPECT Imaging in Pediatric Patients with Neurally Mediated Reflex Syncope

Ilgin, Neşe; Olguntürk, Rana; Kula, Serdar; Turan, L; Tunaoğlu, Sedef; Temiz, H; Gökçora, Nahide; Gücüyener, Kıvılcım

doi:10.1111/j.1540-8159.2005.09317.x

Cited by 7 publications

(6 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Two previous studies indicated that the cerebral perfusion deficits during reflex syncope are most prominent in the frontal regions. 35,36 Accordingly, cognitive executive functions in patients with syncope due to OH were greatly affected by an orthostatic challenge. 37 However, in a separate publication on the current cohort, we found no evident effects of the identified deep WMLs on cognitive functioning.…”

Section: Resultsmentioning

confidence: 99%

Syncope and orthostatic intolerance increase risk of brain lesions in migraineurs and controls

et al. 2013

View full text Add to dashboard Cite

Objectives: We and others showed that migraineurs are at increased risk of subclinical and clinical ischemic brain lesions. Migraineurs also have a higher prevalence of frequent syncope and orthostatic intolerance, symptoms that are associated with transient reductions in cerebral blood flow. In this study, we assessed whether these autonomic symptoms may contribute to the increased risk of brain lesions in migraine.Methods: Migraineurs (n 5 291) and controls (n 5 140) from the population-based, cross-sectional CAMERA (Cerebral Abnormalities in Migraine, an Epidemiologic Risk Analysis) cohort (aged 30-60 years, and free of other neurologic symptoms) underwent 1) brain MRI scan, and 2) structured telephone interview including questions on frequent syncope ($5/lifetime) and orthostatic intolerance.Results: Frequent syncope (odds ratio [OR] 5 2.7; 95% confidence interval: 1.3-5.5) and orthostatic intolerance (OR 5 2.0 [1.1-3.6]) were independent risk factors for high load of deep white matter lesions. Effects were strongest in women and similar in migraineurs and controls. Migraine diagnosis did not mediate or moderate these associations. Individuals with orthostatic intolerance had higher prevalence of high periventricular white matter lesion load (OR 5 1.9 [1.1-3.5]). Syncope and orthostatic intolerance were not related to subclinical infarcts or infratentorial lesions. Migraine is a common neurovascular brain disorder characterized by attacks of disabling headache, autonomic dysfunction, and sometimes aura symptoms. Conclusions:1 Although suffering a migraine attack is ranked among the most painful and disabling disorders, 2 the disease migraine is commonly not believed to have long-term brain consequences.However, we found in the population-based CAMERA (Cerebral Abnormalities in Migraine, an Epidemiologic Risk Analysis) study that female migraineurs are at increased risk of deep white matter hyperintense lesions (WMLs), and that both male and female migraineurs have a higher prevalence of infratentorial brain lesions, including hyperintense brainstem lesions and cerebellar infarcts.3,4 This association was not modified by cardiovascular risk factors or use of vasoconstricting antimigraine medication. These MRI lesions appear to have developed subclinically, but they might still be relevant in view of the findings of a meta-analysis showing that migraine is a risk factor for ischemic stroke.5 Furthermore, WMLs have in general a predictive value for future stroke and cognitive and functional decline. 6 The mechanisms leading to increased risk of brain lesions in migraineurs remain unknown.

show abstract

Section: Resultsmentioning

confidence: 99%

Syncope and orthostatic intolerance increase risk of brain lesions in migraineurs and controls

et al. 2013

View full text Add to dashboard Cite

show abstract

“…The close anatomical relationship between these areas may explain the decrease in rCBF in the anterior insula and the adjacent basal and lateral temporal areas in this study. A previous SPECT study performed in pediatric patients showed that subjects with a positive tilt test had regional differences in brain perfusion, with significantly lower perfusion of the right peri-insular, posterior parietal and temporal regions compared to negative tilt test patients [17] and the reduction in rCBF in these specific areas is known to be a direct effect of the enhanced vagal reflex that leads to syncope. An rCBF decrease confined to the right insula is known to be the final trigger responsible for the reduction of heart rate and blood pressure [12].…”

Section: Discussionmentioning

confidence: 97%

“…Mean cerebral perfusion, expressed as average count densities, decreased upon provocation compared with baseline and the hypoperfusion was most pronounced in the frontal lobe. These results suggest that cerebral perfusion decreases markedly in subjects with cardiovascular vasodepressor syncope, but these studies were performed during syncopal episodes and the method with region of interest was adopted for cerebral perfusion analysis [17,34]. In the present study we used a statistical parametric mapping (SPM) technique for localizing brain regions with significant rCBF changes during the asymptomatic period in syncope patients.…”

Section: Introductionmentioning

confidence: 97%

“…Until now, little data have been available on cerebral perfusion in patients with syncope. To assess regional differences in cerebral blood flow, brain single photon emission computed tomography (SPECT) has been performed during tilt testing in pediatric patients with syncope [17]. This study demonstrated that passive orthostatism can cause a diffuse and left hemisphere-dominant reduction in cerebral perfusion.…”

Section: Introductionmentioning

confidence: 97%

See 1 more Smart Citation

Cerebral blood flow abnormalities in patients with neurally mediated syncope

et al. 2010

View full text Add to dashboard Cite

The aim of this study is to investigate regional cerebral blood flow (rCBF) in patients with syncope. We compared brain single photon emission computed tomography (SPECT) images of neurally mediated syncope patients with those of age/sex matched healthy volunteers. (99m)Tc-ethylcysteinate dimer (ECD) brain SPECT was performed in 35 patients (M/F = 17/18, mean 36.6 years) with syncope during the asymptomatic period, and in 35 healthy volunteers. For statistical parametric mapping (SPM) analysis, all SPECT images were spatially normalized to the standard SPECT template and then smoothed using a 14-mm full width at half maximum Gaussian kernel. The mean duration of syncope history was 4.9 years and the mean number of syncope episodes was 6.3. In all patients, syncope or presyncope episodes occurred during head-up tilt tests, and all were the vasodepressive type. SPM analysis of brain SPECT images showed significantly decreased rCBF in the right anterior insular cortex, left parahippocampal gyrus, bilateral fusiform gyri, bilateral middle and inferior temporal gyri, left lingual gyrus, bilateral precuneus and bilateral posterior lobes of the cerebellum in syncope patients at a false discovery rate corrected p < 0.05. There were no brain regions that showed increased rCBF in syncope patients. Furthermore, we found a negative correlation between the total number of syncopal episodes and the rCBF of the right prefrontal cortex, and between the duration of syncope history and the rCBF of the right cingulate gyrus at uncorrected p < 0.001. Decreases of rCBF in multiple brain regions may be responsible for autonomic dysregulation and improper processing of emotional stress in neurally mediated syncope patients, and frequent syncope episodes may lead to frontal dysfunction.

show abstract

“…Studies by using SPECT showed decreases in regional cerebral blood flow in multiple cortical regions, yielding inconsistent results across the studies. [35][36][37] The results of these SPECT studies might be interpreted as a consequence of cerebral hypoperfusion rather than a specific cause of NCS. To our knowledge, there is only 1 exploratory VBM study that showed a reduction of GM volume in the medulla in patients with NCS.…”

Section: Discussionmentioning

confidence: 99%