신경심장성실신 환자들에서 중대뇌대동맥과 후대뇌동맥의 뇌혈관 반응 차이
Differences in Reactivity of Middle and Posterior Cerebral Artery in Patients with Neurocardiogenic Syncope
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Background: Neurocardiogenic syncope (NCS) is the most common type of neurally mediated syncopes. Though presyncopal symptoms may represent hypoperfusion in posterior circulation, studies for evaluating the cerebrovascular response of posterior circulation in patients with NCS were scanty. We evaluated the cerebrovascular response of the posterior circulation using transcranial Doppler monitoring in patients with NCS. Methods: We measured the blood flow velocity (BFV) of the middle cerebral artery (MCA) and contralateral posterior cerebral artery (PCA) simultaneously in 11 patients with a diagnosis of NCS both at rest and during the head-up tilt test (HUT) for 5 minutes. The mean arterial pressure (MAP), pulse rate (PR), and end-tidal pCO2 (EtCO2) were also monitored. The obtained data were compared with those of 17 normal control subjects. Results: The syncope patients showed a significantly larger decline in BFV of PCA (P<0.05) and a larger increase in pulsatility indexes of MCA and PCA during HUT compared to those of control subjects. In control subjects BFV of PCA decreased less than those of MCA. On the contrary, in patients with NCS, those of PCA decreased more. These different regional cerebrovascular responses to HUT were accompanied with neither presyncopal symptoms nor decrease in MBP. Conclusions: The regional cerebrovascular response to HUT in NCS patients was different in the PCA flow. Impairment of autonomic neural control of posterior circulation may play an important role in the pathophysiology of NCS.
Abstract
Background: Neurocardiogenic syncope (NCS) is the most common type of neurally mediated syncopes. Though presyncopal symptoms may represent hypoperfusion in posterior circulation, studies for evaluating the cerebrovascular response of posterior circulation in patients with NCS were scanty. We evaluated the cerebrovascular response of the posterior circulation using transcranial Doppler monitoring in patients with NCS. Methods: We measured the blood flow velocity (BFV) of the middle cerebral artery (MCA) and contralateral posterior cerebral artery (PCA) simultaneously in 11 patients with a diagnosis of NCS both at rest and during the head-up tilt test (HUT) for 5 minutes. The mean arterial pressure (MAP), pulse rate (PR), and end-tidal pCO2 (EtCO2) were also monitored. The obtained data were compared with those of 17 normal control subjects. Results: The syncope patients showed a significantly larger decline in BFV of PCA (P<0.05) and a larger increase in pulsatility indexes of MCA and PCA during HUT compared to those of control subjects. In control subjects BFV of PCA decreased less than those of MCA. On the contrary, in patients with NCS, those of PCA decreased more. These different regional cerebrovascular responses to HUT were accompanied with neither presyncopal symptoms nor decrease in MBP. Conclusions: The regional cerebrovascular response to HUT in NCS patients was different in the PCA flow. Impairment of autonomic neural control of posterior circulation may play an important role in the pathophysiology of NCS.
참고문헌 (22)
- Savage DD, "Epidemiologic features of isolated syncope: the Framingham Study", Stroke, 16, pp.626~629 (1985)
- Grubb BP, "Clinical disorders of the autonomic nervous system associated with orthostatic intolerance: an overview of classification, clinical evaluation, and management", Pacing Clin Electrophysiol, 22, pp.798~810 (1999)
- Mosqueda-Garcia R, "Fernandez-Violante R. The elusive pathophysiology of neurally mediated syncope", Circulation, 102, pp.2898~2906 (2000)
- Milstein S, "Usefulness of disopyramide for prevention of upright tilt-induced hypotension-bradycardia", Am J Cardiol, 65, pp.1339~1344 (1990)
- Wallin BG, "Sympathetic outflow to muscles during vasovagal syncope", J Auton Nerv Syst, 6, pp.287~291 (1982)
- Albina G, "Transcranial doppler monitoring during head upright tilt table testing in patients with suspected neurocardiogenic syncope", Europace, 6, pp.63~69 (2004)
- Carey BJ, "Cerebral autoregulatory responses to head-up tilt in normal subjects and patients with recurrent vasovagal syncope", Circulation, 104, pp.898~902 (2001)
- Grubb BP, "Cerebral vasoconstriction during head-upright tilt-induced vasovagal syncope. A paradoxic and unexpected response", Circulation, 84, pp.1157~1164 (1991)
- Brooks DJ, "The effect of orthostatic hypotension on cerebral blood flow and middle cerebral artery velocity in autonomic failure, with observations on the action of ephedrine", J Neurol Neurosurg Psychiatry, 52, pp.962~966 (1989)
- Dan D, "Cerebral blood flow velocity declines before arterial pressure in patients with orthostatic vasovagal presyncope", J Am Coll Cardiol, 39, pp.1039~1045 (2002)
- Novak V, "Hypocapnia and cerebral hypoperfusion in orthostatic intolerance", Stroke, 29, pp.1876~1881 (1998)
- Schondorf R, "Cerebrovascular and cardiovascular measurements during neurally mediated syncope induced by head- up tilt", Stroke, 28, pp.1564~1568 (1997)
- Soo-Jin Cho, "Changes of cerebral blood flow during head-up tilt test in patients with recurrent syncope and presyncope", J Korean Neurol Assoc, 17, pp.376~383 (1999)
- Aaslid R, "Cerebral autoregulation dynamics in humans", Stroke, 20, pp.45~52 (1989)
- Carey BJ, "critical closing pressure and cerebral haemodynamics prior to vasovagal syncope in humans", Clin Sci (Lond), 101, pp.351~358 (2001)
- Schondorf R, "Cupples W. Dynamic cerebral autoregulation is preserved in neurally mediated syncope", J Appl Physiol, 91, pp.2493~2502 (2001)
- Lagi A, "Cerebral vasoconstriction in vasovagal syncope: Any link with symptoms? A transcranial doppler study", Circulation, 104, pp.2694~2698 (2001)
- Thijs RD, "Syncope in migraine: the population-based CAMERA study", Neurology, 66, pp.1034~1037 (2006)
- Silvestrini M, "Basilar and middle cerebral artery reactivity in patients with migraine", Headache, 44, pp.29~34 (2004)
- Edvinsson L, "Autonomic nerves, mast cells, and amine receptors in human brain vessels. A histochemical and pharmacological study", Brain Res, 115, pp.377~393 (1976)
- Hinchey J, "A reversible posterior leukoencephalopathy syndrome", N Engl J Med, 334, pp.494~500 (1996)
- Cooke WH, "Human responses to upright tilt: a window on central autonomic integration", J Physiol, 517, pp.617~628 (1999)