Transient Cerebral Circulatory Arrest Coincides With Fainting in Cough Syncope

Mattle, Heinrich; Nirkko, Arto C.; Baumgartner, Ralf W.; Sturzenegger, Matthias

doi:10.1212/wnl.45.3.498

Cited by 74 publications

(46 citation statements)

References 9 publications

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“…1 Such large increases in intrathoracic pressure alter the systemic and cerebral circulations dramatically and could precipitate cerebral catastrophes. 5,6 Under experimental conditions, phasic changes in blood pressure (BP) and other cardiovascular variables during the VM have been well characterized to examine the integrity of autonomic function. 2,7 However, owing to the relative inaccessibility of the cerebral circulation and the limitations in technology for the measurement of cerebral blood flow (CBF) with high temporal resolution, changes in cerebral hemodynamics during the VM have rarely been studied.…”

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confidence: 99%

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Cerebral Hemodynamics During the Valsalva Maneuver

Zhang

Crandall

Levine

2004

Stroke

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Background and Purpose-The aim of this study was to differentiate the mechanical effects of the Valsalva maneuver (VM) from the effects of changes in autonomic neural activity on cerebral hemodynamics in humans. Methods-Nine healthy subjects performed the VM before and after autonomic ganglionic blockade with trimethaphan.Blood pressure (BP) was measured in the radial artery with an indwelling catheter or at the finger by Finapres. Cerebral blood flow (CBF) velocity was measured in the middle cerebral artery with transcranial Doppler; end-tidal CO 2 was measured by mass spectrometry. Results-Before blockade, during phase II of the VM, BP was reduced by 27% and CBF velocity was reduced by 33%(magnitude of changes during phase II divided by baseline measurements before the VM, PϽ0.05). Cerebrovascular conductance index (CVCI) increased by 21%. During phase IV, overshoot of CBF velocity was proportionately greater than that of BP (46% versus 30%). After blockade, during phase II, BP fell to a much greater degree by 50%, while CBF velocity decreased even more by 60% associated with an increase in CVCI by 33%. During phase IV, despite the absence of BP overshoot, CBF velocity still increased by 55% and CVCI by 33%. Both were significantly greater than before blockade. Conclusions-After ganglionic blockade, cerebral autoregulation is unable to prevent the substantial fall in CBF induced by the marked reduction in BP during the VM. Enhanced phase IV increases in both CBF velocity and CVCI reflect the intrinsic characteristics of cerebral hyperemic responses, which are likely modified in part by the removal of vasoconstrictor effects of autonomic neural activity elicited during the VM.

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confidence: 99%

“…1,2 Occasionally, syncope or even death may occur under these circumstances. 1,5,6 However, changes in cerebral hemodynamics under these conditions (ie, primarily the mechanical effects of the VM) have not been elucidated.…”

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confidence: 99%

Cerebral Hemodynamics During the Valsalva Maneuver

Zhang

Crandall

Levine

2004

Stroke

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“…Both the magnitude and duration of the consequent hypotension are greater than in other fainters, and the hypotensive-triggered compensatory positive chronotropic response is absent or markedly suppressed [14,15]. Other suggested mechanisms indicates that the increased intra-thoracic pressure during coughing is transmitted to the cerebrospinal fluid, causing an acute pressure increase in the skull, compromising cerebral perfusion and resulting in syncope [16,21]. Complete atrioventricular block in patients with left bundle branch block [19], carotid sinus hypersensitivity [20], sinus arrest in patients with sick sinus [22], and synergistic effect between jugular venous reflex and plasma endothelin-1 levels [23] have also been suggested.…”

Section: Discussionmentioning

confidence: 99%

Recurrent Cough Syncope Due to Pertussis in Adults: Report of Three Cases and Review of the Literature

et al. 2016

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Cough syncope, also called "tussive syncope", is a well-recognized syndrome for about 70 years, in which loss of consciousness usually occurs immediately after a violent cough or prolonged bouts of violent coughing, lasting for seconds with rapid restoration of full consciousness. Its precise pathophysiologic mechanism is not fully understood and remains a matter of debate. Although pertussis is a frequent cause of prolonged cough in adults, still its burden in this age group is under-appreciated and under-diagnosed worldwide. This is well reflected by the fact that despite cough syncope is definitely not rare, until yet only six cases of cough syncope related to pertussis have been reported in the medical literature, one of them by us. We describe additional three adults with recurrent cough syncope due to pertussis who were diagnosed during a period of 3 months which completely resolved by treatment with azithromycin. Diagnosing four cases of cough syncope in adults due to pertussis during a short period in one Department of Internal Medicine, while only five cases were reported from the rest of the world, reflects the great lack of awareness on adult pertussis worldwide. Our four cases indicate that physicians should be much more aware of pertussis as a cause of cough and cough syncope in adults in order to terminate the attacks of cough and cough syncope and its serious complications by adequate antibiotic treatment, as happened with our four patients.

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“…Both the magnitude and duration of the consequent hypotension are greater than in other fainters, and the hypotensive-triggered compensatory positive chronotropic response is absent or markedly suppressed [10,11]. Other suggested mechanism indicates that the increased intra-thoracic pressure during coughing is transmitted to the cerebrospinal fluid, causing an acute pressure increase in the skull, compromising cerebral perfusion and resulting in syncope [12,17]. Synergistic effect between jugular venous reflex and plasma endothelin-1 levels [18], and carotid sinus hypersensitivity [16], complete atrioventricular block [15] and sinus arrest [19], has also been suggested.…”

Section: Discussionmentioning

confidence: 99%

Recurrent Cough Syncope Due to Pertussis in an Adult: A Case Report and Review of the Literature

Dawood¹,

Elias²,

Slobodin³

et al. 2015

J Med Cases

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Cough syncope is a well-recognized syndrome in which loss of consciousness usually occurs immediately after prolonged bouts of violent coughing lasting for seconds, with rapid and complete recovery of consciousness. Its pathophysiology is still incompletely understood. Although pertussis is a common cause of cough and cough syncope is not rare, to the best of our knowledge, only five cases of cough syncope related to pertussis have been previously reported, two of which are not well documented. We describe a 52-year-old male who presented to the emergency department with cough and recurrent episodes of cough syncope of 3 months duration due to pertussis which was completely resolved by treatment with azithromycin. Since pertussis is a common cause of subacute and chronic cough in adolescents and adults, and the clinical characteristics of pertussis among adults are less obvious than among children, it seems likely that cough syncope due to pertussis is underdiagnosed. It is important for the physicians to be aware of pertussis as a cause of chronic cough and cough syncope in adults in order to terminate the attacks by adequate antibiotic treatment.

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Transient Cerebral Circulatory Arrest Coincides With Fainting in Cough Syncope

Cited by 74 publications

References 9 publications

Cerebral Hemodynamics During the Valsalva Maneuver

Cerebral Hemodynamics During the Valsalva Maneuver

Recurrent Cough Syncope Due to Pertussis in Adults: Report of Three Cases and Review of the Literature

Recurrent Cough Syncope Due to Pertussis in an Adult: A Case Report and Review of the Literature

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