Cerebral blood flow abnormalities in patients with neurally mediated syncope

Joo, Eun Yeon; Hong, Seung Bong; Lee, Minjoo Larry; Tae, Woo Suk; Lee, James; Han, Suk Won; Ji, Ki‐Hwan; Suh, Minah

doi:10.1007/s00415-010-5759-1

Cited by 8 publications

(10 citation statements)

References 36 publications

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“…36 Apparently, the maximum CBF decreases (76 AE 8%) in microvasculature found in the present study were larger than the maximum drops of mean CBFV (58 AE 14%) 35 or diastolic CBFV (∼40%) 36 in MCA measured by Doppler ultrasound, implying that CBF in small vessels may be more sensitive than CBFV in large vessels for the assessment of VVS. In addition, Joo et al reported that CBF in small vessels of the right prefrontal cortex measured by SPECT during HUT was negatively correlated to the total number of syncopal episodes, 17 which had been demonstrated to be the most powerful predictor of a future syncope. 37 Therefore, CBF measurement holds potential to evaluate the recurrence rate of VVS.…”

Section: Discussionmentioning

confidence: 99%

“…The right insular cortex is known to be responsible for regulating sympathetic activities such as HR and blood pressure. 10,17 It is possible that reduced CBF in the right insular cortex suppresses sympathetic activities, eventually leading to VVS. 17 As expected, cerebral hypoperfusion (i.e., CBF decline) occurred during presyncope along with cerebral hypoxia (i.e., ½HbO 2 decrease and [Hb] increase).…”

Section: Discussionmentioning

confidence: 99%

“…Single photon emission computed tomography (SPECT) has also been used to evaluate the regional difference of CBF in small vessels during VVS induced by HUT. 17 However, low temporal resolution and high cost limit its clinical application. Furthermore, SPECT involves exposure to ionizing radiation.…”

Section: Introductionmentioning

confidence: 99%

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Near-infrared diffuse optical monitoring of cerebral blood flow and oxygenation for the prediction of vasovagal syncope

et al. 2014

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Abstract. Significant drops in arterial blood pressure and cerebral hemodynamics have been previously observed during vasovagal syncope (VVS). Continuous and simultaneous monitoring of these physiological variables during VVS is rare, but critical for determining which variable is the most sensitive parameter to predict VVS. The present study used a novel custom-designed diffuse correlation spectroscopy flow-oximeter and a finger plethysmograph to simultaneously monitor relative changes of cerebral blood flow (rCBF), cerebral oxygenation (i.e., oxygenated/deoxygenated/total hemoglobin concentration: r½HbO 2 ∕r½Hb∕rTHC), and mean arterial pressure (rMAP) during 70 deg head-up tilt (HUT) in 14 healthy adults. Six subjects developed presyncope during HUT. Two-stage physiological responses during HUT were observed in the presyncopal group: slow and small changes in measured variables (i.e., Stage I), followed by rapid and dramatic decreases in rMAP, rCBF, r½HbO 2 , and rTHC (i.e., Stage II). Compared to other physiological variables, rCBF reached its breakpoint between the two stages earliest and had the largest decrease (76 AE 8%) during presyncope. Our results suggest that rCBF has the best sensitivity for the assessment of VVS. Most importantly, a threshold of ∼50% rCBF decline completely separated the subjects from those without presyncope, suggesting its potential for predicting VVS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Near-infrared diffuse optical monitoring of cerebral blood flow and oxygenation for the prediction of vasovagal syncope

et al. 2014

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“…Of interest, a recent study demonstrated cerebral blood flow abnormalities in patients with syncope in their asymptomatic period (i.e., between syncopal attacks). 27 The purpose of this study was to evaluate whether clinical symptoms of ANS dysfunction increase the risk of WMLs, and whether this effect is influenced by the presence of migraine.…”

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confidence: 99%

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

et al. 2013

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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.

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“…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: 94%