The incidence of coexistent autonomic and vestibular dysfunction in patients with postural dizziness

Heidenreich, Katherine D.; Weisend, Stacy; Fouad‐Tarazi, Fetnat M.; White, Judith

doi:10.1016/j.amjoto.2008.04.011

Cited by 9 publications

(3 citation statements)

References 15 publications

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“…4 In one study, no association was found between caloric responses and tilt test results, but all patients were tested more than 1 week after onset of symptoms, allowing a period of vestibular and autonomic compensation before laboratory testing. 5 In contrast, our patients were seen while acutely symptomatic, indicating limited compensation.…”

Section: Discussioncontrasting

confidence: 62%

Orthostatic Intolerance in Acute Vestibular Neuritis

Whitman

Yates

2015

Mayo Clinic Proceedings

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Section: Discussioncontrasting

confidence: 62%

Orthostatic Intolerance in Acute Vestibular Neuritis

Whitman

Yates

2015

Mayo Clinic Proceedings

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“…In a study designed to determine the incidence of the coexistence of vestibular and cardiovascular autonomic dysfunction, Heidenreich et al (137) undertook a retrospective study of patients (n=56) with a primary presenting complaint of dizziness exacerbated by changes in posture. These patients had also been tested for orthostatic intolerance using a tilt table and for vestibular dysfunction using caloric tests, ocular motor and positional testing, and assessment of the vestibulo-ocular reflex involving the rotating chair test.…”

Section: Vestibulosympathetic Reflexes Evoked By Natural Stimulation mentioning

confidence: 99%

Vestibulo‐Sympathetic Responses

Yates

Bolton

Macefield

2014

Comprehensive Physiology

144

130

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Evidence accumulated over 30 years, from experiments on animals and human subjects, has conclusively demonstrated that inputs from the vestibular otolith organs contribute to the control of blood pressure during movement and changes in posture. This review considers the effects of gravity on the body axis, and the consequences of postural changes on blood distribution in the body. It then separately considers findings collected in experiments on animals and human subjects demonstrating that the vestibular system regulates blood distribution in the body during movement. Vestibulosympathetic reflexes differ from responses triggered by unloading of cardiovascular receptors such as baroreceptors and cardiopulmonary receptors, as they can be elicited before a change in blood distribution occurs in the body. Dissimilarities in the expression of vestibulosympathetic reflexes in humans and animals are also described. In particular, there is evidence from experiments in animals, but not humans, that vestibulosympathetic reflexes are patterned, and differ between body regions. Results from neurophysiological and neuroanatomical studies in animals are discussed that identify the neurons that mediate vestibulosympathetic responses, which include cells in the caudal aspect of the vestibular nucleus complex, interneurons in the lateral medullary reticular formation, and bulbospinal neurons in the rostral ventrolateral medulla (RVLM). Recent findings showing that cognition can modify the gain of vestibulosympathetic responses are also presented, and neural pathways that could mediate adaptive plasticity in the responses are proposed, including connections of the posterior cerebellar vermis with the vestibular nuclei and brainstem nuclei that regulate blood pressure.

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“…delta), or with the rate of blood pressure recovery [13,14]. However, OI may also be caused by conditions other than blood pressure changes, such as vestibular [15,16] or psychosomatic [17] disorders. Indeed, OI is a heterogeneous syndrome [18,19].…”

Section: Introductionmentioning

confidence: 99%

Insights into the clinical management of the syndrome of supine hypertension – orthostatic hypotension (SH-OH): The Irish Longitudinal Study on Ageing (TILDA)

et al. 2013

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BackgroundOur previously proposed morphological classification of orthostatic hypotension (MOH) is an approach to the definition of three typical orthostatic hemodynamic patterns using non-invasive beat-to-beat monitoring. In particular, the MOH pattern of large drop/non-recovery (MOH-3) resembles the syndrome of supine hypertension–orthostatic hypotension (SH-OH), which is a treatment challenge for clinicians. The aim of this study was to characterise MOH-3 in the first wave of The Irish Longitudinal Study of Ageing (TILDA), with particular attention to concurrent symptoms of orthostatic intolerance (OI), prescribed medications and association with history of faints and blackouts.MethodsThe study included all TILDA wave 1 participants who had a Finometer® active stand. Automatic data signal checks were carried out to ensure that active stand data were of sufficient quality. Characterisation variables included demographics, cardiovascular and neurological medications (WHO-ATC), and self-reported information on comorbidities and disability. Multivariable statistics consisted of logistic regression models.ResultsOf the 4,467 cases, 1,456 (33%) were assigned to MOH-1 (small drop, overshoot), 2,230 (50%) to MOH-2 (medium drop, slower but full recovery), and 781 (18%) to MOH-3 (large drop, non-recovery). In the logistic regression model to predict MOH-3, statistically significant factors included being on antidepressants (OR = 1.99, 95% CI: 1.50 – 2.64, P < 0.001) and beta blockers (OR = 1.60, 95% CI: 1.26 – 2.04, P < 0.001). MOH-3 was an independent predictor of OI after full adjustment (OR = 1.47, 95% CI: 1.25 – 1.73, P < 0.001), together with being on hypnotics or sedatives (OR = 1.83, 95% CI: 1.31 – 2.54, P < 0.001). In addition, OI was an independent predictor of history of falls/blackouts after full adjustment (OR = 1.27, 95% CI: 1.09 – 1.48, P = 0.003).ConclusionsAntidepressants and beta blockers were independently associated with MOH-3, and should be used judiciously in older patients with SH-OH. Hypnotics and sedatives may add to the OI effect of MOH-3. Several trials have demonstrated the benefits of treating older hypertensive patients with cardiovascular medications that were not associated with adverse outcomes in our study. Therefore, the evidence of benefit does not necessarily have to conflict with the evidence of potential harm.

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The incidence of coexistent autonomic and vestibular dysfunction in patients with postural dizziness

Cited by 9 publications

References 15 publications

Orthostatic Intolerance in Acute Vestibular Neuritis

Orthostatic Intolerance in Acute Vestibular Neuritis

Vestibulo‐Sympathetic Responses

Insights into the clinical management of the syndrome of supine hypertension – orthostatic hypotension (SH-OH): The Irish Longitudinal Study on Ageing (TILDA)

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