Abstract
Orthostatic dysregulation (OD) has been classified into subtypes by heart rate and blood pressure; however, the hemodynamics of brains have not yet been revealed. Therefore, we investigated changes in cerebral blood flow and oxygenation during an active standing test to clarify the pathophysiology of two subtypes: postural tachycardia syndrome (POTS) and neurally mediated syncope (NMS). We studied 31 children (15 boys, 16 girls; mean age, 14.0 ± 1.7 years) who presented with OD at the Department of Pediatrics and Child Health, Nihon University School of Medicine between 2009 and 2011. OD was diagnosed using the Japanese clinical guidelines for juvenile orthostatic dysregulation. After a 10-min resting period in the supine position, patients were asked to quickly stand up and keep upright for 10 min. Cerebral blood flow and cerebral oxygenation were measured using transcranial Doppler sonography and near-infrared spectroscopy. POTS showed a significant decrease of oxy-Hb and resistance index (RI), suggesting transient ischemia with maintainable cerebral autoregulation. NMS showed a decrease of oxy-Hb and an increase of RI, suggesting ischemia and impairment of autoregulation.
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Okuni M (1962) Orthostatic dysregulation in childhood with special reference to the standing electrocardiogram. Jpn Circ J 27:200–204
Tanaka H, Fujita Y, Takenaka Y et al (2009) Japanese clinical guidelines for juvenile orthostatic dysregulation version 1. Pediatr Int 51:169–179
Warkentin S, Passant U, Minthon L et al (1992) Redistribution of blood flow in the cerebral cortex of normal subjects during head-up postural change. Clin Auton Res 2:119–124
Novak V, Novak P, Spies JM et al (1998) Autoregulation of cerebral blood flow in orthostatic hypotension. Stroke 29:104–111
Van Lieshout JJ, Wieling W, Karemaker JM et al (2003) Syncope, cerebral perfusion, and oxygenation. J Appl Physiol 94:833–848
Mehagnoul-Schipper DJ, Colier WNJM, Jansen RWMM (2001) Reproducibility of orthostatic changes in cerebral oxygenation in healthy subjects aged 70 years of older. Clin Physiol 21:77–84
Harms MP, Colier WN, Wieling W et al (2000) Orthostatic intolerance, cerebral oxygenation, and blood velocity in humans with sympathetic failure. Stroke 31:1608–1614
Elwell CE, Owen Reece H, Wyatt JS et al (1996) Influence of respiration and changes in expiratory pressure on cerebral haemoglobin concentration measured by near infrared spectroscopy. J Cereb Blood Flow Metab 16:353–357
Kim YT, Tanaka H, Takaya R et al (2009) Quantitative study on cerebral blood volume determined by a near-infrared spectroscopy during postural change in children. Acta Paediatr 98:466–471
Grubb BP, Kosinski DJ (2001) Syncope resulting from autonomic insufficiency syndromes associated with orthostatic intolerance. Med Clin North Am 85:457–472
Sung RYT, Du ZD, Yu CW et al (2000) Cerebral blood flow during vasovagal syncope induced by active standing or head up tilt. Arch Dis Child 82:154–158
Aaslid R, Markwalder T, Nornes H (1982) Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries. J Neurosurg 57:769–774
Aaslid R (1986) The Doppler principle applied to measurement of blood flow velocity in cerebral arteries. In: Aaslid R (ed) Transcranial Doppler sonography. Springer, Wein, pp 39–69
Miyagawa M (1989) Cerebral blood flow in orthostatic dysregulation. Auton Nerv Syst 26:25–30 (In Japanese with English abstract)
Delpy DT, Cope M, van der Zee P et al (1988) Estimation of optical pathlength through tissue from direct of flight measurement. Phys Med Biol 33:1433–1442
Toet MC, Lemmers PM, van Schelven LJ et al (2006) Cerebral oxygenation and electrical activity after birth asphyxia: their relation to outcome. Pediatrics 117:333–339
Nagamitsu S, Nagano M, Yamashita Y et al (2006) Prefrontal cerebral blood volume patterns while playing video games – a near-infrared spectroscopy study. Brain Dev 28:315–321
Tanaka H, Matsushima R, Tamai H et al (2002) Impaired postural cerebral hemodynamics in young patients with chronic fatigue with and without orthostatic intolerance. J Pediatr 140:412–417
Hoshi Y, Shida N, Tamura M et al (1993) Study of cerebral hemodynamics in patients with orthostatic dysregulation by near-infrared spectrophotometry. J Jpn Pediatr Soc 97:692–698 (In Japanese with English abstract)
Soga T, Nozaki Y, Tatsuno M et al (1995) Evaluation of the cerebral blood volume in children with orthostatic dysregulation using near infrared spectroscopy. Showa Univ J Med Sci 55:392–398 (In Japanese with English abstract)
Acknowledgments
This research was partly supported by a Grant-in-Aid from the Ministry of Education, Culture, Sports, Sciences and Technology of Japan (B23300247), and grants by Alpha Electron Co., Ltd. (Fukushima, Japan) and Iing Co., Ltd. (Tokyo, Japan).
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Endo, A., Fujita, Y., Fuchigami, T., Takahashi, S., Mugishima, H., Skatani, K. (2014). Changes in Cerebral Blood Oxygenation Induced by Active Standing Test in Children with POTS and NMS. In: Swartz, H.M., Harrison, D.K., Bruley, D.F. (eds) Oxygen Transport to Tissue XXXVI. Advances in Experimental Medicine and Biology, vol 812. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0620-8_34
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DOI: https://doi.org/10.1007/978-1-4939-0620-8_34
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