Orthostatic hypotension in acute cerebellar infarction

Kim, Hyun-Ah; Lee, Hyung

doi:10.1007/s00415-015-7945-7

Cited by 10 publications

(7 citation statements)

References 24 publications

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“…For example, similar to postural symptomatology commonly seen with autonomic dysfunction, cerebellar dizziness induced by a change in position from sitting to standing, has also been reported in posterior cerebellar and vermis lesions (Bodranghien et al, 2016). Furthermore, following an acute cerebellar infarct, one study found that 28% of patients developed postural dizziness on standing and 31% showed evidence of adrenergic dysfunction characterized by orthostatic hypotension and absent adrenergic phases in response to Valsalva maneuver (Kim and Lee, 2016). Therefore, reduced cerebellar-brainstem connectivity may not only worsen postural symptoms, but also contribute further to adrenergic failure and autonomic dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Reduced brainstem functional connectivity in patients with peripheral autonomic failure

Baker

Kimpinski

2019

NeuroImage: Clinical

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Autonomic homeostasis is dependent upon several brainstem nuclei, as well as several cortical and subcortical structures. Together, these sites make up, in part, the central autonomic network. Neurogenic orthostatic hypotension (NOH) is a cardinal feature of autonomic failure that occurs due to a failure to increase sympathetic efferent activity in response to postural changes. Therefore, the purpose of the current study was to investigate brainstem functional connectivity in NOH patients with peripheral autonomic lesions resulting in autonomic failure. Fifteen controls (63 ± 13 years) and fifteen Neurogenic Orthostatic Hypotension patients (67 ± 6 years; p = .2) with peripheral autonomic dysfunction completed 5-min of rest and three Valsalva maneuvers during a functional brain scan. Functional connectivity from the brainstem to cortical and subcortical structures were contrasted between patients and controls. At rest controls had significantly greater brainstem connectivity to the anterior cingulate cortex (T-value: 4.29), left anterior insula (T-value:3.31), left putamen (T-value:3.31) and bilateral thalamus (T RIGHT -value: 3.83; T LEFT -value:4.25) (p-FDR < 0.005). During Valsalva, controls showed significantly more connectivity between the brainstem and both the left anterior (cerebellum 4/5) and bilateral posterior cerebellum (cerebellar 9 and left cerebellar 6). Other cerebellar regions included brainstem-to-vermis. Other brainstem-to-cortical and subcortical regions included: bilateral putamen, posterior cingulate cortex (PCC), amygdala and medial prefrontal cortex. There was a significant negative correlation between the brainstem-cerebellar connectivity and severity of autonomic dysfunction ( p < .01). During recovery phase of the Valsalva, controls had greater brainstem connectivity to the left thalamus (T-value:4.17); PCC (T-value:3.32); right putamen (T-value:3.28); right paracingulate gyrus (T-value:3.25) and left posterior cerebellum (C9) (T-value:3.21) (p-FDR < 0.05). The effect sizes for each brainstem connectivity during Valsalva and recovery ranged from moderate to strong. Patients with autonomic failure show reduced coupling between the brainstem and regions of the central autonomic network, including the cerebellum, insula, thalamus and cingulate cortices. Connectivity was associated with autonomic impairment. These findings may suggest impaired brainstem connectivity in patients with autonomic failure.

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Section: Discussionmentioning

confidence: 99%

Reduced brainstem functional connectivity in patients with peripheral autonomic failure

Baker

Kimpinski

2019

NeuroImage: Clinical

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“…Several studies have described OH in association with isolated cerebellar lesions in humans [107][108][109]. OH was found in 31% of the patients (9/29) with isolated cerebellar lesions and the most common pattern of OH was the transient OH right after tilting (7/9, 80%).…”

Section: Vestibular Disorders Can Cause Hemodynamic Orthostatic Dizzimentioning

confidence: 99%

“…OH was found in 31% of the patients (9/29) with isolated cerebellar lesions and the most common pattern of OH was the transient OH right after tilting (7/9, 80%). The medial part of the superior semilunar lobule and the tonsil were more commonly involved in the OH group [ 109 ]. Cardiovascular responses during orthostasis in cerebellar lesions require further elucidation.…”

Section: Commentsmentioning

confidence: 99%

Hemodynamic orthostatic dizziness/vertigo: Diagnostic criteria

Kim

Bisdorff

Bronstein

et al. 2019

VES

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This paper presents the diagnostic criteria for hemodynamic orthostatic dizziness/vertigo to be included in the International Classification of Vestibular Disorders (ICVD). The aim of defining diagnostic criteria of hemodynamic orthostatic dizziness/vertigo is to help clinicians to understand the terminology related to orthostatic dizziness/vertigo and to distinguish orthostatic dizziness/vertigo due to global brain hypoperfusion from that caused by other etiologies. Diagnosis of hemodynamic orthostatic dizziness/vertigo requires: A) five or more episodes of dizziness, unsteadiness or vertigo triggered by arising or present during upright position, which subsides by sitting or lying down; B) orthostatic hypotension, postural tachycardia syndrome or syncope documented on standing or during head-up tilt test; and C) not better accounted for by another disease or disorder. Probable hemodynamic orthostatic dizziness/vertigo is defined as follows: A) five or more episodes of dizziness, unsteadiness or vertigo triggered by arising or present during upright position, which subsides by sitting or lying down; B) at least one of the following accompanying symptoms: generalized weakness/tiredness, difficulty in thinking/concentrating, blurred vision, and tachycardia/palpitations; and C) not better accounted for by another disease or disorder. These diagnostic criteria have been derived by expert consensus from an extensive review of 90 years of research on hemodynamic orthostatic dizziness/vertigo, postural hypotension or tachycardia, and autonomic dizziness. Measurements

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“…Previous studies with small numbers of patients (N 12–36) have suggested that HUT is well-tolerated in acute stroke patients, these studies included both ischemic and hemorrhagic strokes and one study included only cerebellar infarctions [ 33 – 36 ]. Our results from 67 mild ischemic stroke patients who tolerated active standing, undergoing HUT in an acute stroke setting are in accordance with these studies.…”

Section: Discussionmentioning

confidence: 99%

Autonomic dysfunction after mild acute ischemic stroke and six months after: a prospective observational cohort study

et al. 2023

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Introduction Autonomic dysfunction is prevalent in ischemic stroke patients and associated with a worse clinical outcome. We aimed to evaluate autonomic dysfunction over time and the tolerability of the head-up tilt table test in an acute stroke setting to optimize patient care. Patients and method In a prospective observational cohort study, patients were consecutively recruited from an acute stroke unit. The patients underwent heart rate and blood pressure analysis during the Valsalva maneuver, deep breathing, active standing, and head-up tilt table test if active standing was tolerated. In addition, heart rate variability and catecholamines were measured. All tests were performed within seven days after index ischemic stroke and repeated at six months follow-up. Results The cohort was comprised of 91 acute stroke patients, mean (SD) age 66 (11) years, median (IQR) initial National Institute of Health Stroke Scale 2 (1–4) and modified Ranking Scale 2 (1–3). The head-up tilt table test revealed 7 patients (10%) with orthostatic hypotension. The examination was terminated before it was completed in 15%, but none developed neurological symptoms. In the acute state the prevalence of autonomic dysfunction varied between 10–100% depending on the test. No changes were found in presence and severity of autonomic dysfunction over time. Conclusion In this cohort study of patients with mild stroke, autonomic dysfunction was highly prevalent and persisted six months after index stroke. Head-up tilt table test may be used in patients who tolerate active standing. Autonomic dysfunction should be recognized and handled in the early phase after stroke.

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Orthostatic hypotension in acute cerebellar infarction

Cited by 10 publications

References 24 publications

Reduced brainstem functional connectivity in patients with peripheral autonomic failure

Reduced brainstem functional connectivity in patients with peripheral autonomic failure

Hemodynamic orthostatic dizziness/vertigo: Diagnostic criteria

Autonomic dysfunction after mild acute ischemic stroke and six months after: a prospective observational cohort study

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