Increased Pulsatile Cerebral Blood Flow, Cerebral Vasodilation, and Postsyncopal Headache in Adolescents

Ocon, Anthony J.; Messer, Zachary R.; Medow, Marvin S.; Stewart, Julian M.

doi:10.1016/j.jpeds.2011.04.006

Cited by 10 publications

(12 citation statements)

References 37 publications

(59 reference statements)

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“…Loss of consciousness usually occurs if systolic blood pressure declines to 60 mmHg [21] that is accompanied by cerebral vasodilation [15]. In this study, the CBFv pattern was similar in all types of syncope.…”

Section: Neurally Mediated Syncopesupporting

confidence: 59%

“…In this study, the CBFv pattern was similar in all types of syncope. The diastolic CBFv was close or equal to zero, the mean CBFv was less than 30 cm/sec, and pulsatility index increased which is consistent with cerebral vasodilation [15]. It is advantageous to use CBFv in differentiation of pseudosyncope or spurious decline in finger blood pressure; in both conditions CBFv remains stable.…”

Section: Neurally Mediated Syncopesupporting

confidence: 53%

“…Bradycardia or asystole predominates in cardioinhibitory syncope and both mechanisms (vasodilatation and cardioinhibition) are present in mixed syncope [3]. CBFv has characteristic pattern during syncope consistent with cerebral vasodilation as indicted by increased systolic and decreased diastolic CBFv and thus increased pulsatility index defined as systolic CBFv -diastolic CBFv [15]. In this study, the VASIS (Vasovagal Syncope International Study) classification [16] of syncope has been expanded using the CBFv and blood pressure criteria (Table 1).…”

Section: Neurally Mediated (Reflex) Syncopementioning

confidence: 99%

“…Paroxysmal PST in this study was defined as intermittent (duration < 2 minutes) tachycardia (heart rate > 100 bpm [17]) associated with heart QASAT [7]-orthostatic hypotension during the tilt = 0 AND QASAT [15]-cerebral blood flow response to tilt > 1 AND QASAT [3]-increased heart rate response to tilt = 0 Orthostatic hypertension syndrome (OHTN)…”

Section: Paroxysmal Sinus Tachycardia (Pst)mentioning

confidence: 99%

“…QASAT [7]-orthostatic hypotension during the tilt = 0 AND QASAT [10]-orthostatic hypertension during the tilt = 1 AND QASAT [15]-cerebral blood flow response to tilt = 0 AND QASAT [3]-increased heart rate response to tilt = 0…”

Section: Paroxysmal Sinus Tachycardia (Pst)mentioning

confidence: 99%

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Autonomic Dysfunction in Dizziness Clinic

Cho¹,

Park²

2018

Res Vestib Sci

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Objective. The head-up tilt test is widely used for evaluation of orthostatic intolerance. Although orthostatic symptoms usually reflect cerebral hypoperfusion, the cerebral blood flow velocity (CBFv) profile in orthostatic syndromes is not well described. This study evaluated CBFv and cardiovascular patterns associated with the tilt test in common orthostatic syndromes. Methods. This retrospective study analyzed the tilt test of patients with history of orthostatic intolerance. The following signals were recorded: ECG, blood pressure, CBFv using transcranial Doppler, respiratory signals, and end tidal CO 2 . Results. Data from 744 patients were analyzed. Characteristic pattern associated with a particular orthostatic syndrome can be grouped into abnormalities predominantly affecting blood pressure (orthostatic hypotension, orthostatic hypertension syndrome, vasomotor oscillations, and neurally mediated syncope-cardioinhibitory, vasodepressor, and mixed), cerebral blood flow (orthostatic hypoperfusion syndrome, primary cerebral autoregulatory failure), and heart rate (tachycardia syndromes: postural tachycardia syndrome, paroxysmal sinus tachycardia, and inappropriate sinus tachycardia). Psychogenic pseudosyncope is associated with stable CBFv. Conclusions. The tilt test is useful add-on in diagnosis of several orthostatic syndromes. However diagnostic criteria for several syndromes had to be modified to allow unambiguous pattern classification. CBFv monitoring in addition to blood pressure and heart rate may increase diagnostic yield of the tilt test.

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Section: Neurally Mediated Syncopesupporting

confidence: 59%

Section: Neurally Mediated Syncopesupporting

confidence: 53%

Section: Neurally Mediated (Reflex) Syncopementioning

confidence: 99%

Section: Paroxysmal Sinus Tachycardia (Pst)mentioning

confidence: 99%

Section: Paroxysmal Sinus Tachycardia (Pst)mentioning

confidence: 99%

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Autonomic Dysfunction in Dizziness Clinic

Cho¹,

Park²

2018

Res Vestib Sci

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A framework to simplify paediatric syncope diagnosis

et al. 2023

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This paper aims to improve the diagnosis of syncope and transient loss of consciousness (TLOC) in children. Diagnostic problems stem, first, from some causes spanning various disciplines, e.g. cardiology, neurology and psychiatry, while the most common cause, vasovagal syncope, is not embraced by any specialty. Second, clinical variability is huge with overlapping signs and symptoms. Third, the approach to TLOC/syncope of the European Society of Cardiology (ESC) is underused in childcare. We explain the ESC guidelines using an additional paediatric literature review. Classification of TLOC and syncope is hierarchic and based on history taking. Loss of consciousness (LOC) is defined using three features: abnormal motor control including falling, reduced responsiveness and amnesia. Adding a < 5 min duration and spontaneous recovery defines TLOC. TLOC simplifies diagnosis by excluding long LOC (e.g. some trauma, intoxications and hypoglycaemia) and focussing on syncope, tonic–clonic seizures and functional TLOC. Syncope, i.e. TLOC due to cerebral hypoperfusion, is divided into reflex syncope (mostly vasovagal), orthostatic hypotension (mostly initial orthostatic hypotension in adolescents) and cardiac syncope (arrhythmias and structural cardiac disorders). The initial investigation comprises history taking, physical examination and ECG; the value of orthostatic blood pressure measurement is unproven in children but probably low. When this fails to yield a diagnosis, cardiac risk factors are assessed; important clues are supine syncope, syncope during exercise, early death in relatives and ECG abnormalities. Conclusions: In adults, the application of the ESC guidelines reduced the number of absent diagnoses and costs; we hope this also holds for children. What is Known:• Syncope and its mimics are very common in childhood, as they are at other ages.• Syncope and its mimics provide considerable diagnostic challenges. What is New:• Application of the hierarchic framework of transient loss of consciousness (TLOC) simplifies diagnosis.• The framework stresses history-taking to diagnose common conditions while keeping an eye on cardiac danger signs.

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