Redistribution of blood flow in the cerebral cortex of normal subjects during head-up postural change

Warkentin, Siegbert; Passant, Ulla; Minthon, Lennart; Karlson, Sara; Edvinsson, Lars; Fäldt, R.; Gustafson, Lars; Risberg, Jarl

doi:10.1007/bf01819667

Cited by 32 publications

(22 citation statements)

References 18 publications

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“…However, a recent study using PET in normal subjects revealed that rCBF values were increased in the cerebellar vermis and remained unchanged in the cerebellar hemispheres during the upright test, being in concordance with the notion that the cerebellar vermis is a neural substrate for controlling voluntary upright posture, and the use of the cerebellar hemisphere as a reference ROI seems to be validated [25]. In normal subjects, rCBF value measured by the xenon-133 inhalation method has been reported to decrease mildly in the frontal area during a head-up tilt [34]. However, in the present study, the CBF ratio in the frontal ROI was unchanged after rising in the lacunar infarction or control group.…”

Section: Discussionsupporting

confidence: 65%

Cerebral vasomotor reactivity to postural change is impaired in patients with cerebrovascular white matter lesions

Ohtani¹,

Tomimoto²,

Kawasaki

et al. 2003

Journal of Neurology

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Vasomotor reactivity is decreased in terms of cerebral blood flow (CBF) response to hypercapnia in patients with cerebrovascular white matter (WM) lesions. This study evaluated whether vasomotor reactivity is altered during postural change in these patients. We examined 28 consecutive patients with cerebrovascular WM lesions, subgrouped into 19 with Schmidt scale 2 and 9 with scale 3 WM lesions. These patients were compared with 15 age-matched patients with lacunar infarction but without significant WM lesions and 6 controls without cerebrovascular disease. With blood pressure monitoring, brain SPECT scans were done in the supine and upright position using HMPAO as a tracer. The ratio of radioisotope (RI) counts in the frontal and parieto-temporal lobes to those in the cerebellar hemispheres (CBF ratio) was evaluated. In the comparison among the three groups, there were no significant differences in the changes of systemic blood pressure after rising. The baseline CBF ratio in the supine position was also not different among the three groups. After rising, the CBF ratio in each region of interest (ROI) did not change significantly in either lacunar infarction or control groups. By contrast, in patients with WM lesions, the CBF ratio in the frontal lobe decreased after rising (p < 0.0001). In the subgroup analysis, there was a significant increase in blood pressure 1, 2 and 3 min after rising (p < 0.05), with a higher tendency in the scale 3 WM lesion group as compared to the scale 2 WM lesion group. The CBF ratio was decreased in both frontal and parieto-temporal areas in the scale 2 WM lesion group, whereas this was significant only in the frontal areas in the scale 3 WM lesion group. Vasomotor reactivity is impaired in cerebrovascular WM lesions, suggesting a susceptibility to postural changes in these patients.

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Section: Discussionsupporting

confidence: 65%

Cerebral vasomotor reactivity to postural change is impaired in patients with cerebrovascular white matter lesions

Ohtani¹,

Tomimoto²,

Kawasaki

et al. 2003

Journal of Neurology

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“…Due to similar decreases in PET CO 2 during orthostatic stress between sexes (as observed by Ref. 68) and greater reactivity to CO 2 in women, our primary hypothesis is that there will be a greater reduction in cerebral blood flow in upright postures in young women compared with young men. Furthermore, CO 2 reactivity decreases with age in women to a level equal with that of age-matched men (28).…”

mentioning

confidence: 64%

Hemodynamics and brain blood flow during posture change in younger women and postmenopausal women compared with age-matched men

Edgell

Robertson

Hughson

2012

Journal of Applied Physiology

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Edgell H, Robertson AD, Hughson RL. Hemodynamics and brain blood flow during posture change in younger women and postmenopausal women compared with age-matched men. J Appl Physiol 112: 1482-1493, 2012. First published February 23, 2012 doi:10.1152/japplphysiol.01204.2011.-Increased incidence of orthostatic hypotension and presyncopal symptoms in young women could be related to hormonal factors that might be isolated by comparing cardiovascular and cerebrovascular responses to postural change in young and older men and women. Seven young women, 11 young men, 10 older women (Ͼ1 yr postmenopausal, no hormone therapy), and 9 older men participated in a supine-to-sit-to-stand test while measuring systemic hemodynamics, end-tidal PCO2, and blood flow velocity of the middle cerebral artery (MCA). Women had a greater reduction in stroke volume index compared with age-matched men (change from supine to standing: young women: Ϫ22.9 Ϯ 1.6 ml/m 2 ; young men: Ϫ14.4 Ϯ 2.4 ml/m 2 ; older women: Ϫ17.4 Ϯ 3.3 ml/m 2 ; older men: Ϫ13.8 Ϯ 2.2 ml/m 2 ). This was accompanied by offsetting changes in heart rate, particularly in young women, resulting in no age or sex differences in cardiac output index. Mean arterial pressure (MAP) was higher in older subjects and increased with movement to upright postures. Younger men and women had higher forearm vascular resistance that increased progressively in the upright posture compared with older men and women. There was no difference between sexes or ages in total peripheral resistance index. Women had higher MCA velocity, but both sexes had reduced MCA velocity while upright, which was a function of reduced blood pressure at the MCA and a significant reduction in end-tidal PCO2. The reductions in stroke volume index suggested impaired venous return in women, but augmented responses of heart rate and forearm vascular resistance protected MAP in younger women. Overall, these results showed significant sex and age-related differences, but compensatory mechanisms preserved MAP and MCA velocity in young women. cerebrovascular; sex; age; orthostatic ORTHOSTATIC HYPOTENSION (a condition that sometimes leads to fainting) is an important and sometimes dangerous condition that particularly affects young women during daily life, as reflected by admission to emergency rooms (51). It has been speculated that female sex hormones might modulate reflex neural or vascular properties, resulting in the greater incidence of orthostatic hypotension in young women (5,14,15,52,69). An additional indication of impaired orthostatic responses in women includes the observation that women have a greater propensity towards postural orthostatic tachycardia syndrome (18, 60).Contrary to observations for young women, clinical evidence supports the concept that orthostatic hypotension occurs less frequently in women ages 40 -60 yr (many of whom could be postmenopausal) (51). Investigations of men and women from 23-77 yr of age indicated that the heart rate response to tilt was reduced with aging, but vascular responses a...

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“…A relatively high fre quency of syncopal attacks has been reported in Pick's disease and therefore our observations of low mean blood pressure and a tendency to orthostatic blood pressure drop in FLD may be of special interest [24]. Neurological symptoms such as fascicular twitchings, muscular wast ing, dysarthria, dysphagia and extrapyramidal signs may develop in patients with FLD as also described in Pick's disease.…”

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confidence: 69%

Clinical Picture of Frontal Lobe Degeneration of Non-Alzheimer Type

Gustafson¹

1993

Dement Geriatr Cogn Disord

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116

102

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Frontal lobe degeneration of non-Alzheimer type (FLD) is the second most common primary degenerative dementia in southern Sweden. Clinical findings in 30 FLD cases with postmortem-verified diagnoses are described. FLD starts in the presenium with a mean disease duration of 7.5 years (range 3-17 years). Clinical onset is insidious and slow and the early stage is dominated by personality changes with lack of insight and judgement and signs of disinhibition. A typical feature is progressive loss of expressive speech with stereotyped phrases, late mutism and amimia. Restlessness, changes of oral/dietary behavior and utilization behavior are prevalent as also psychotic features. Temporal and spatial orientation are usually preserved for a long time in contrast to Alzheimer''s disease. Dementia in FLD is similar to that of Pick''s disease and ALS with dementia. Early recognition of FLD seems possible based on standardized clinical evaluation supported by neuropsychological tests, measurement of regional cerebral blood flow and other types of brain imaging. The etiology of FLD is unknown but a positive heredity was reported in 60%.

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Redistribution of blood flow in the cerebral cortex of normal subjects during head-up postural change

Cited by 32 publications

References 18 publications

Cerebral vasomotor reactivity to postural change is impaired in patients with cerebrovascular white matter lesions

Cerebral vasomotor reactivity to postural change is impaired in patients with cerebrovascular white matter lesions

Hemodynamics and brain blood flow during posture change in younger women and postmenopausal women compared with age-matched men

Clinical Picture of Frontal Lobe Degeneration of Non-Alzheimer Type

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