Preservation of autoregulation of cerebral blood flow in autonomic failure

This case demonstrates severe autonomic failure with orthostatic hypotension affecting cardiovagal and sympathetic adrenergic fibers and associated with small fiber neuropathy. Small fiber neuropathy is severe, mixed, and affecting sensory and autonomic fibers, non–length-dependent. Orthostatic cerebral blood flow velocity was reduced throughout the tilt, indicative of autoregulation failure.

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Case 59: Small Fiber Neuropathy and Autonomic Failure with Elevated Voltage-Gated Potassium Channel Antibodies

Autonomic Testing ◽

10.1093/med/9780190889227.003.0064 ◽

2019 ◽

pp. 316-319

Author(s):

Peter Novak

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Potassium Channel ◽

Blood Flow Velocity ◽

Cerebral Blood Flow Velocity ◽

Autonomic Failure ◽

Small Fiber Neuropathy ◽

Voltage Gated ◽

Cerebral Vasoconstriction ◽

Small Fiber

This case demonstrates severe autonomic failure associated with autoimmune small fiber neuropathy that was positive for elevated voltage-gated potassium channel (VGKC) antibodies. Adrenergic autonomic failure is associated with orthostatic hypotension. Low cerebral blood flow velocity during the tilt was associated with cerebral vasoconstriction.

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Pathophysiology of post-prandial hypotension in patients with progressive autonomic failure. IV. Cerebral blood flow during post-prandial hypotension

Journal of the Autonomic Nervous System ◽

10.1016/s0165-1838(95)90097-7 ◽

1995 ◽

Vol 50 (3) ◽

pp. 368

Author(s):

Masaaki Hirayama ◽

Akito Kume ◽

Takashi Katoh ◽

Yasuo Koike ◽

Yuko Takeuchi ◽

...

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Autonomic Failure

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Case 40: Parkinson’s Disease with Compensated Orthostatic Hypotension

Autonomic Testing ◽

10.1093/med/9780190889227.003.0045 ◽

2019 ◽

pp. 233-236

Author(s):

Peter Novak

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Blood Flow ◽

Cerebral Blood Flow ◽

Orthostatic Hypotension ◽

Autonomic Failure ◽

Neurogenic Orthostatic Hypotension ◽

Supine Hypertension ◽

Reduced Flow

Autonomic failure manifesting as neurogenic orthostatic hypotension and supine hypertension are common manifestations of cardiovascular dysautonomia in Parkinson’s disease. Depending on the cerebral blood flow, neurogenic orthostatic hypotension can be either compensated (with stable orthostatic cerebral blood flow) and noncompensated (with reduced flow).

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Case 22: Orthostatic Cerebral Hypoperfusion Syndrome in Anaphylaxis

Autonomic Testing ◽

10.1093/med/9780190889227.003.0027 ◽

2019 ◽

pp. 149-152

Author(s):

Peter Novak

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Orthostatic Hypotension ◽

Flow Velocity ◽

Blood Flow Velocity ◽

Cerebral Blood Flow Velocity ◽

Autonomic Failure ◽

Cerebral Hypoperfusion ◽

Tilt Test

Tilt test showed a typical orthostatic cerebral hypoperfusion syndrome (OCHOS). The OCHOS pattern is characterized by reduced orthostatic cerebral blood flow velocity (CBFv) without orthostatic hypotension, tachycardia, or hypocapnia and no evidence of adrenergic autonomic failure.

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