Elevated cerebral blood flow in patients with pure autonomic failure

Trujillo, Paula; Román, O; Hay, Kaitlyn R; Juttukonda, Meher R.; Yan, Yan; Kang, Hakmook; Paranjape, Sachin Y.; Garland, Emily M.; Shibao, Cyndya A.; Biaggioni, Italo; Donahue, Manus J.; Claassen, Daniel O.

doi:10.1007/s10286-021-00792-8

Cited by 3 publications

(3 citation statements)

References 35 publications

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“…Recently, cerebral blood flow to the grey matter was found to be higher in PAF when compared to the control population. [ 42 ] However, its significance in the pathophysiology of PAF is not yet clear. Similarly, the role of genetic factors in PAF needs to be studied in detail.…”

Section: O Ur V Iewpoint On the ...mentioning

confidence: 99%

Pure Autonomic Failure-A Localized Alpha Synucleinopathy with a Potential for Conversion to More Extensive Alpha Synucleinopathies

Bhattacharjee¹,

Alsukhni²

2022

Annals of Indian Academy of Neurology

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Pure autonomic failure (PAF) is an alpha synucleinopathy with predominant involvement of the autonomic ganglia and peripheral nerves. The hallmark clinical feature is orthostatic hypotension. However, genitourinary, sudomotor, and cardiac involvement is also common. Many patients also develop supine hypertension. Almost a quarter of patients can phenoconvert or evolve into Parkinson's disease, multiple system atrophy, and Lewy body dementia in the future. Early severe bladder involvement, higher supine noradrenaline level, early motor involvement, and dream enactment behavior increase the risk of phenoconversion. The diagnosis is confirmed via autonomic function testing and serum noradrenaline measurement. The treatment is mainly supportive. The non-pharmacological treatment includes adequate fluid, dietary salt, compression stockings, and abdominal binders. The drug therapies to improve blood pressure include midodrine, fludrocortisone, pyridostigmine, and droxidopa. The diagnostic criteria need to be updated to incorporate the recent understandings. The treatment of orthostatic hypotension and supine hypertension is mainly based on case series and anecdotal reports. Randomized control trials are needed to ascertain the best treatment strategies for PAF.

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Section: O Ur V Iewpoint On the ...mentioning

confidence: 99%

Pure Autonomic Failure-A Localized Alpha Synucleinopathy with a Potential for Conversion to More Extensive Alpha Synucleinopathies

Bhattacharjee¹,

Alsukhni²

2022

Annals of Indian Academy of Neurology

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“…First, the original hypothesis that CBF would be lower in PAF, although not explicitly explained by the authors, was probably based on the notion that patients with PAF have supine hypertension, and that hypertension is associated with lower CBF [8]. In support of this hypothesis, within the group of PAF patients, higher supine BP was indeed associated with lower CBF in PAF [7]. However, overall, CBF was substantially (on average 10 ml/min/100 g) higher in patients with PAF than in controls.…”

mentioning

confidence: 97%

“…In this issue of Clinical Autonomic Research, Trujillo and colleagues, led by Daniel Claassen (no family relationship with me), have used a 'static' method to investigate baseline changes in patients with PAF [7]. Specifically, the authors applied steady-state CBF measurements using MRI arterial spin labeling (ASL).…”

mentioning

confidence: 99%