Right Insular Atrophy in Neurocardiogenic Syncope: A Volumetric MRI Study

Kim, J. B.; Suh, Sang Il; Seo, Woo Keun; Koh, Seong Beom; Kim, Ji Hyun

doi:10.3174/ajnr.a3611

Cited by 20 publications

(18 citation statements)

References 39 publications

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“…Several findings support the notion that cortical thinning may precede the onset of symptoms and induce OH. First, two previous VBM studies investigated the brain volume of patients with OI, especially vasovagal syncope (VVS), and they demonstrated right insular or brainstem atrophy in patients with VVS [6,8]. They suggested that the brain atrophy of the insular cortex or brainstem might decrease the sympathetic activity and lead to VVS [8].…”

Section: Discussionmentioning

confidence: 99%

“…First, two previous VBM studies investigated the brain volume of patients with OI, especially vasovagal syncope (VVS), and they demonstrated right insular or brainstem atrophy in patients with VVS [6,8]. They suggested that the brain atrophy of the insular cortex or brainstem might decrease the sympathetic activity and lead to VVS [8]. Our present study also revealed cortical thinning in the orbitofrontal, post-central, and inferior temporal cortexes, which are areas known to be associated with the regulation of the autonomic nervous systems, and these findings consistently supported the susceptibility to OH in patients with OH [13,14,15].…”

Section: Discussionmentioning

confidence: 99%

“…Third, some studies support the hemispheric lateralization of ANS. A previous VBM study did not demonstrate a volume reduction in the left insular cortex, but did show a reduction in the right insular cortex in patients with VVS [8]. Another study that utilized the intra-carotid amobarbital sodium test in temporal lobe epilepsy revealed that the right cerebral hemisphere, rather than the left hemisphere, predominantly modulated sympathetic activity [16].…”

Section: Discussionmentioning

confidence: 99%

“…Some evidence suggests that brain abnormalities are associated with OI [4,5,6,7,8]. Several cases have reported that structural abnormalities in the brain may induce OI because specific brain regions modulate the cardiovascular autonomic nervous system (ANS) [4,5].…”

Section: Introductionmentioning

confidence: 99%

“…Several cases have reported that structural abnormalities in the brain may induce OI because specific brain regions modulate the cardiovascular autonomic nervous system (ANS) [4,5]. Moreover, previous studies have demonstrated a volume reduction of the brain in patients with OI [6,7,8]. However, no studies have investigated the cortical morphology of the brain in patients with OI.…”

Section: Introductionmentioning

confidence: 99%

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Cortical Morphology in Patients with Orthostatic Intolerance

Shin

Kim²,

Han³

et al. 2015

Eur Neurol

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Background: We evaluated the cortical morphology in patients with orthostatic intolerance. Methods: Thirty patients with orthostatic intolerance, as well as age- and sex-matched normal controls, were enrolled in this study. We divided the patients into orthostatic hypotension (n = 22) and postural tachycardia syndrome (n = 8) groups based on their response to a head-up tilt table test. We analyzed whole-brain T1-weighted MRI images using FreeSurfer 5.1. The measures of cortical morphology were compared between the groups. Results: The cortical thickness in the right hemisphere, including the medial orbitofrontal, peri-calcarine, post-central, inferior temporal, and lateral occipital cortex, and in the peri-calcarine cortex of the left hemisphere was thinned in patients with orthostatic hypotension compared to normal controls. The other measures of cortical morphology, including the surface area, volume, and curvatures, did not differ between patients with orthostatic hypotension and normal controls. However, none of the measures of cortical morphology differed between patients with postural tachycardia syndrome and normal controls. Conclusions: We demonstrated that the cortical morphology significantly changed in patients with orthostatic hypotension but not in patients with postural tachycardia syndrome compared to normal controls. These findings support the hypothesis that orthostatic intolerance is a heterogeneous syndrome.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cortical Morphology in Patients with Orthostatic Intolerance

Shin

Kim²,

Han³

et al. 2015

Eur Neurol

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Alterations of brain network hubs in reflex syncope: Evidence from a graph theoretical analysis based on DTI

et al. 2018

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ObjectiveWe evaluated global topology and organization of regional hubs in the brain networks and microstructural abnormalities in the white matter of patients with reflex syncope.MethodsTwenty patients with reflex syncope and thirty healthy subjects were recruited, and they underwent diffusion tensor imaging (DTI) scans. Graph theory was applied to obtain network measures based on extracted DTI data, using DSI Studio. We then investigated differences in the network measures between the patients with reflex syncope and the healthy subjects. We also analyzed microstructural abnormalities of white matter using tract‐based spatial statistics analysis (TBSS).ResultsMeasures of global topology were not different between patients with reflex syncope and healthy subjects. However, in reflex syncope patients, the strength measures of the right angular, left inferior frontal, left middle orbitofrontal, left superior medial frontal, and left middle temporal gyrus were lower than in healthy subjects. The betweenness centrality measures of the left middle orbitofrontal, left fusiform, and left lingual gyrus in patients were lower than those in healthy subjects. The PageRank centrality measures of the right angular, left middle orbitofrontal, and left superior medial frontal gyrus in patients were lower than those in healthy subjects. Regarding the analysis of the white matter microstructure, there were no differences in the fractional anisotropy and mean diffusivity values between the two groups.ConclusionsWe have identified a reorganization of network hubs in the brain network of patients with reflex syncope. These alterations in brain network may play a role in the pathophysiologic mechanism underlying reflex syncope.

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Is postural orthostatic tachycardia syndrome (POTS) a central nervous system disorder?

Blitshteyn

2021

J Neurol

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Postural orthostatic tachycardia syndrome (POTS), a disorder of the autonomic nervous system characterized by a rise in heart rate of at least 30 bpm from supine to standing position, has been traditionally viewed as a dysfunction of the peripheral nervous system. However, recent studies and evidence from overlapping conditions suggest that in addition to being considered a disorder of the peripheral nervous system, POTS should be viewed also as a central nervous system (CNS) disorder given (1) significant CNS symptom burden in patients with POTS; (2) structural and functional differences found on neuroimaging in patients with POTS and other forms of orthostatic intolerance; (3) evidence of cerebral hypoperfusion and possible alteration in cerebrospinal fluid volume, and (4) positive response to medications targeting the CNS and non-pharmacologic CNS therapies. This review outlines existing evidence of POTS as a CNS disorder and proposes a hypothetical model combining key mechanisms in the pathophysiology of POTS. Redefining POTS as a CNS disorder can lead to new possibilities in pharmacotherapy and non-pharmacologic therapeutic interventions in patents affected by this disabling syndrome.

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Right Insular Atrophy in Neurocardiogenic Syncope: A Volumetric MRI Study

Cited by 20 publications

References 39 publications

Cortical Morphology in Patients with Orthostatic Intolerance

Cortical Morphology in Patients with Orthostatic Intolerance

Alterations of brain network hubs in reflex syncope: Evidence from a graph theoretical analysis based on DTI

Is postural orthostatic tachycardia syndrome (POTS) a central nervous system disorder?

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