Increased Pulsatile Cerebral Blood Flow, Cerebral Vasodilation, and Postsyncopal Headache in Adolescents - 14/09/11
Reprint request: Julian M. Stewart, MD, PhD, The Center for Hypotension, New York Medical College, 19 Bradhurst Ave, Suite 1600S Hawthorne, NY 10532.Abstract |
Objective |
We hypothesize that, after a sudden decrease in cerebral blood flow velocity (CBFV) in adolescents, a faint, rapid hyperemic pulsatile CBFV occurs upon the patient’s return to the supine position and is associated with postsyncopal headache.
Study design |
This case-control study involved 16 adolescent subjects with a history of fainting and headaches. We induced fainting during 70° tilt-table testing and measured mean arterial pressure, heart rate, end-tidal CO2, and CBFV. Fifteen control subjects were similarly evaluated with a tilt but did not faint, and comparisons with fainters were made at equivalent defined time points.
Results |
Baseline values were similar between the groups. Upon fainting, mean arterial pressure decreased 49% in the patients who fainted vs 6% in controls (P < .001). The heart rate decreased 15% in fainters and increased 35% in controls (P < .001). In patients who fainted, cerebrovascular critical closing pressure increased markedly, which resulted in reduced diastolic (–66%) and mean CBFV (–46%) at faint; systolic CBFV was similar to controls. Pulsatile CBFV (systolic-diastolic CBFV) increased 38% in fainters, which caused flow-mediated dilatation of cerebral vessels. When the fainters returned to the supine position, CBFV exhibited increased systolic and decreased diastolic flows compared with controls (P < .02).
Conclusion |
Increased pulsatile CBFV during and after faint may cause postsyncopal cerebral vasodilation and headache.
Le texte complet de cet article est disponible en PDF.Mots-clés : AP, CBF, CBFV, CCP, CGRP, CO, CVRi, DBP, ETCO2, HR, MAP, MCA, NO, PP, SBP, SV
Plan
| Supported by the National Heart, Lung, and Blood Institute (grants 1-F30-HL-097380, 1-RO1-HL-074873, 1-RO1-HL-087803, 1-R21-HL091948) and a grant from the Chronic Fatigue and Immune Dysfunction Syndrome Association of America. The authors declare no conflict of interest. |
Vol 159 - N° 4
P. 656 - octobre 2011 Retour au numéro
Article précédent
- Plexiform Neurofibromas in Children with Neurofibromatosis Type 1: Frequency and Associated Clinical Deficits
- Rosa Nguyen, Lan Kluwe, Carsten Fuensterer, Michael Kentsch, Reinhard Edgar Friedrich, Victor-Felix Mautner
- Pediatric Venous and Arterial Noncerebral Thromboembolism in Denmark: A Nationwide Population-Based Study
- Ruta Tuckuviene, Anette L. Christensen, Jon Helgestad, Soren P. Johnsen, Soren R. Kristensen
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?