| 반복적인 실신 및 실신전환자의 기립경사 검사시 뇌혈류 변화 |
| 조수진, 김준수*, 이광호, 정진상, 송희정, 이상철*, 서정돈*, 이원로 |
| 성균관대학교 의과대학, 삼성서울병원 |
| Changes of Cerebral Blood Flow during Head-up Tilt Test
in Patients with Recurrent Syncope and Presyncope. |
| Soo-Jin Cho, M.D., June Soo Kim, M.D.*, Kwang-Ho Lee, M.D., Chin-Sang Chung, M.D.,
Hee-Jung Song, M.D., Sang-Chol Lee, M.D.*, Jung Don Seo, M.D.*, Won Ro Lee, M.D.*
Department of Neurology and Cardiovascular Institute, Department of Medicine, |
| Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine
50, Ilwon-dong, Kangnam-ku, Seoul, 135-710, Korea. |
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| Abstract |
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Background: The changes of cerebral hemodynamics during syncope have not been fully evaluated. We investigated
the changes in the cerebral blood flow velocity during head-up tilt test (HUT) using transcranial Doppler ultrasonogra-phy
(TCD) in patients with neurocardiogenic syncope or presyncope. M e t h o d s: Thirty-three patients with a history of
recurrent syncope or presyncope of unknown origin were evaluated using HUT for 30 minutes (baseline tilt test), fol-lowed
by an infusion of intravenous isoproterenol if needed. Systolic (SV) and diastolic velocities (DV) of middle cere-bral
artery were continuously monitored by TCD. Positive responses were defined as presyncope or syncope with
hypotension, bradycardia, or both. R e s u l t s: Five patients had positive responses during baseline tilt and 14 patients dur-ing
the isoproterenol infusion. During the baseline tilt test, there was a 86 ± 23% drop in DV and a 41 ± 34% drop in SV
in patients with positive responses, and mean changes in those were less than 10% in patients with negative responses
(p=.00, p=.00). During the HUT with an isoproterenol infusion, the TCD showed an 80 ± 18% drop in diastolic velocity
in patients with positive responses, and a 47 ± 10% drop in patients with negative responses (p=.00), However, the
change in systolic velocity did not differ. TCD showed three patterns during positive responses: loss of all flow, loss of
end-diastolic flow, and a decrease in diastolic velocity. Loss of consciousness occurred in patients with loss of all flow or
end-diastolic flow during positive responses. C o n c l u s I o n s: TCD shows different patterns of changes in cerebral hemody-namics
during HUT. TCD can be used to investigate the pathophysiology of neurocardiogenic syncope.
J Kor Neurol Ass 17(3):376 ~ 383, 1999
Key Words : Neurocardiogenic syncope, Syncope, Cerebral hemodynamics, Transcranial Doppler Ultrasonography,Head-up tilt test |
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