Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-24T09:41:26.871Z Has data issue: false hasContentIssue false

Cerebral blood flow of children with vasovagal syncope

Published online by Cambridge University Press:  02 January 2014

Barsan Tugba
Affiliation:
Department of Pediatric Cardiology, Eskisehir Osmangazi University, Eskisehir, Turkey
Kilic Zubeyir
Affiliation:
Department of Pediatric Cardiology, Eskisehir Osmangazi University, Eskisehir, Turkey
Uzuner Nevzat
Affiliation:
Department of Neurology, Eskisehir Osmangazi University, Eskisehir, Turkey
Yildirim Ali*
Affiliation:
Department of Pediatric Cardiology, Eskisehir Osmangazi University, Eskisehir, Turkey
Ucar Birsen
Affiliation:
Department of Pediatric Cardiology, Eskisehir Osmangazi University, Eskisehir, Turkey
Demir Tevfik
Affiliation:
Department of Pediatric Cardiology, Eskisehir Osmangazi University, Eskisehir, Turkey
*
Correspondence to: Y. Ali, Department of Pediatric Cardiology, Eskisehir Osmangazi University, Eskisehir 26480, Turkey. Tel: 0902222392979; Fax: 0902222395400; E-mail: [email protected]

Abstract

Introduction: We aimed to evaluate changes in the cerebral blood supply in children during vasovagal syncope and to clarify the diagnostic value of transcranial Doppler for vasovagal syncope. Materials and methods: Patients were divided into three groups. Group 1 consisted of 31 patients who were symptomatic and whose head-up tilt test was positive. Group 2 comprised 21 patients who were symptomatic but whose tilt test was negative. Group 3 included 22 healthy children. For the diagnosis of vasovagal syncope, the tilt test was applied. For the subjects of the patient and control groups, the tilt test was repeated. The flow rates of bilateral middle cerebral arteries were continuously and simultaneously recorded with temporal window transcranial Doppler. Results: There were no statistically significant differences between the three groups with respect to age and gender distribution (p>0.05). When the bed was at an upright position, the maximum blood flow rate of the right middle cerebral artery was lower in Group 1 than in Group 2, although the decrease was more significant in comparison to the healthy control group (p<0.05). The minimum blood flow rate of the right middle cerebral artery was lower in Group 1 than the Group 2, although the decrease was more significant in comparison with the healthy control group (p<0.05). The maximum blood flow rate of the left middle cerebral artery was significantly lower in Group 1 than in the control group (p<0.05). Conclusion: Minimum and maximum blood flow rates are significantly decreased in patients tilt test (+) patients with vasovagal syncope during orthostatic stress.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Myung, K. Park Pediatric Cardiology for Practitioners, 5th edn. Mosby Elsevier, Philadelphia, 2008.Google Scholar
2. Mcload, KA. Syncope in childhood. Arch Dis Child 2003; 88: 350353.CrossRefGoogle Scholar
3. Driscoll, DJ, Jacobsen, SJ, Porter, CJ. Syncope in children and adolescents. J Am Coll Cardiol 1997; 29: 10391045.Google Scholar
4. Schondorf, R, Benoit, J, Wein, T. Cerebrovascular and cardiovascular measurements during neurally mediated syncope induced by head-up tilt. Stroke 1997; 28: 15641568.Google Scholar
5. Albina, G, Cisneros, LA, Laino, R, et al. Transcranial Doppler monitoring during head upright tilt table testing in patients with suspected neurocardiogenic syncope. Europace 2004; 6: 6369.CrossRefGoogle ScholarPubMed
6. Strandgaard, S, Olesen, J, Skinhoj, E, Lasson, NA. Autoregulation of brain circulation in severe arterial hypertension. Br Med J 1973; 1: 507510.CrossRefGoogle ScholarPubMed
7. Schondorf, R, Stein, R, Roberts, R, Benoit, J, Cupples, W. Dynamic cerebral autoregulation is preserved in neurally mediated syncope. J Appl Physiol 2001; 91: 24932502.Google Scholar
8. Sung, RYT, Du, ZD, Yu, CW, Yam, MC, Fok, TF. Cerebral blood flow during vasovagal syncope induced by active standing or head up tilt. Arch Dis Child 2000; 82: 154158.Google Scholar
9. Grubb, BP, Samoil, D, Kosinski, D. Cerebral syncope: loss of consciousness associated with cerebral vasoconstriction in the absence of systemic hypotension. Pacing Clin Electrophysiol 1998; 21: 652658.Google Scholar
10. Hugh, D. Moss and Adam’s Heart Disease in Infants, Children and Adolescents, 7th edn. Lippincott Williams & Wilkins, Philadelphia, 2008.Google Scholar
11. Sheldon, R, Killam, S. Methodology of isoproterenol-tilt table testing in patients with syncope. J Am Coll Cardiol 1992; 19: 773779.CrossRefGoogle ScholarPubMed
12. Zhang, QY, Du, JB, Li, WZ. A study on the clinical characteristics and follow-up of postural orthostatic tachycardia syndrome in children. Zhanghua Er Ke Za Zhi 2005; 43: 165169.Google Scholar
13. Wen, C, Wang, C, Li, W, et al. Clinical analysis of vasovagal syncope in children. Zhangguo Dang Dai Er Ke Za Zhi 2010; 12: 723725.Google Scholar
14. Gajek, J, Zyśko, D, Mazurek, W. Efficacy of tilt training in patients with vasovagal syncope. Kardiyol Pol 2006; 64: 602608.Google Scholar
15. McGavigan, AD, Hood, S. The influence of sex and age on response to head-up tilt-table testing in patients with recurrent syncope. Age Ageing 2001; 30: 295298.Google Scholar
16. Raviele, A, Menozzi, C, Brignole, M, Gasparini, G, Alboni, P, Musso, G. Value of head-up tilt testing potentiated with sublingual nitroglycerin to assess the origin of unexplained syncope. Am J Cardiol 1995; 76: 267272.Google Scholar
17. Benditt, DG, Lurie, KG, Adler, SW, Sakaguchi, SW. Rationale and methodology of head-up tilt table testing for evaluation of neurally mediated (cardioneurogenic) syncope. In: Zipes DP, Jalife J (eds). Cardiac Electrophysiology: From Cell to Bedside. WB Saunders, Philadelphia, 1995, pp 11151128.Google Scholar
18. Zaidi, A, Benitez, D, Gaydecki, PA, Vohra, A, Fitzpatrick, AP. Haemodynamic efects of increasing angle of head up tilt. Heart 2000; 83: 181184.Google Scholar
19. Matalon, SV, Fahri, LE. Cardiopulmonary readjustments in passive tilt. J Appl Physiol 1979; 47: 503507.CrossRefGoogle ScholarPubMed
20. Voice, RA, Lurie, KG, Sakaguchi, S. Comparison of tilt angles and provocative agents (edrophonium and isoproterenol) to improve head-upright tilt-table testing. Am J Cardiol 1998; 81: 346350.CrossRefGoogle ScholarPubMed
21. Abi-Samra, F, Maloney, JD, Fouad-Tarazi, FM, Castle, LW. The usefulness of head-up tilt testing and hemodynamic investigations in the work up of syncope of unknown origin. Pacing Clin Electrophysiol 1988; 11: 12021214.Google Scholar
22. Aydın, MA, Salukhe, JV, Wilke, I, Willems, S. Management and therapy of vasovagal syncope. World J Cardiol 2010; 2: 308315.Google Scholar
23. DeMey, C, Enterling, D. Assessment of the hemodynamic responses to single passive head-up tilt by non-invasive methods in normotensive subjects. Methods Find Exp Clin Pharmacol 1986; 8: 449457.Google Scholar
24. Fitzpatrick, A, Theodorakis, G, Varda, P. The incidence of malignant vasovagal syndrome in patients with recurrent syncope. Eur Heart J 1991; 12: 389394.Google Scholar
25. Aaslid, R, Markwalder, T, Nomes, H. Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries. J Neurosurg 1982; 57: 769774.CrossRefGoogle ScholarPubMed
26. Tiecks, FP, Lam, AM, Aaslid, R, Newell, D. Comparison of static and dynamic cerebral autoregulation measurements. Stroke 1995; 26: 10141019.Google Scholar
27. Carey, BJ, Manktelow, BN, Panerai, RB, Potter, JF. Cerebral autoregulatory responces to head-up tilt in normal subjects and patients with recurrent vasovagal syncope. Circulation 2001; 104: 898902.Google Scholar
28. Stephenson, JBP. Specific syncopes and anoxic seizure types. In: Stephenson JBP (ed.). Fits and Faints. Mackeith Press, London, 1990, pp 6770.Google Scholar