Case 84: Intermittent Confusion

2019 ◽  
pp. 423-426
Author(s):  
Peter Novak
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Orthostatic Hypotension ◽  
Flow Velocity ◽  
Blood Flow Velocity ◽  
Cerebral Blood Flow Velocity ◽  
Cerebral Hypoperfusion ◽  
Shortness Of Breath ◽  
Cerebral Vasoconstriction ◽  
End Tidal

Short episodes confusion, dizziness, and shortness of breath can be associated with intermittent declines in cerebral blood flow velocity (CBFv). CBFv decline without orthostatic hypotension or decline in end tidal CO2 can be seen in orthostatic cerebral hypoperfusion syndrome (OCHOS) associate with abnormal cerebral vasoconstriction due to cerebral autoregulatory failure.

Case 29: Hypocapnic Cerebral Hypoperfusion

2019 ◽  
pp. 185-188
Author(s):  
Peter Novak
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Flow Velocity ◽  
Autonomic Dysfunction ◽  
Blood Flow Velocity ◽  
Cerebral Blood Flow Velocity ◽  
Cerebral Hypoperfusion ◽  
Tilt Test ◽  
Excessive Sleepiness ◽  
End Tidal

This case presents a patient with extreme fatigue and excessive sleepiness. The tilt test provoked decline in cerebral blood flow velocity (CBFv) associated with decline in end tidal CO2, indicative of hypocapnic cerebral hypoperfusion (HYCH). There was also mild small fiber neuropathy affecting predominantly autonomic fibers associated with mild autonomic dysfunction.

Case 24: Orthostatic Cerebral Hypoperfusion Syndrome with Vision Loss

2019 ◽  
pp. 157-162
Author(s):  
Peter Novak
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Orthostatic Hypotension ◽  
Flow Velocity ◽  
Blood Flow Velocity ◽  
Vision Loss ◽  
Cerebral Blood Flow Velocity ◽  
Cerebral Hypoperfusion ◽  
Tilt Test

The tilt test showed orthostatic cerebral hypoperfusion syndrome (OCHOS) with intermittent reduction in cerebral blood flow velocity and vision loss. OCHOS is associated with reduced orthostatic cerebral blood flow velocity without orthostatic hypotension or arrhythmia.

Case 23: Orthostatic Cerebral Hypoperfusion Syndrome, Severe

2019 ◽  
pp. 153-156
Author(s):  
Peter Novak
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Orthostatic Hypotension ◽  
Flow Velocity ◽  
Blood Flow Velocity ◽  
Cerebral Blood Flow Velocity ◽  
Cerebral Hypoperfusion ◽  
Tilt Test

The tilt test showed severe orthostatic cerebral hypoperfusion syndrome (OCHOS) with reduced cerebral blood flow velocity. OCHOS is associated with reduced orthostatic cerebral blood flow velocity without orthostatic hypotension or arrhythmia.

Case 21: Orthostatic Cerebral Hypoperfusion Syndrome, Intermittent

2019 ◽  
pp. 145-148
Author(s):  
Peter Novak
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Orthostatic Hypotension ◽  
Flow Velocity ◽  
Calcium Channel Blockers ◽  
Blood Flow Velocity ◽  
Cerebral Blood Flow Velocity ◽  
Cerebral Hypoperfusion ◽  
Tilt Test ◽  
Channel Blockers

The tilt test showed mild orthostatic cerebral hypoperfusion syndrome (OCHOS) with intermittent reduction in cerebral blood flow velocity. OCHOS is associated with reduced orthostatic cerebral blood flow velocity without orthostatic hypotension or arrhythmia. Calcium channel blockers may be helpful in OCHOS.

Case 10: Postural Tachycardia Syndrome with Hyperventilation

2019 ◽  
pp. 93-96
Author(s):  
Peter Novak
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Flow Velocity ◽  
Blood Flow Velocity ◽  
Cerebral Blood Flow Velocity ◽  
Cerebral Hypoperfusion ◽  
Common Finding ◽  
Postural Tachycardia Syndrome ◽  
Postural Tachycardia ◽  
End Tidal

Postural tachycardia syndrome (POTS) patients exhibit signs of cerebral hypoperfusion, which is related to a decline in cerebral blood flow velocity (CBFv). End tidal CO2 has profound effects on CBFv. A decline in CBFv in POTS is mainly due to hypocapnia. This is a common finding in POTS.

Case 79: Small Fiber Neuropathy and Abnormal Cerebral Blood Flow

2019 ◽  
pp. 399-402
Author(s):  
Peter Novak
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Orthostatic Hypotension ◽  
Flow Velocity ◽  
Blood Flow Velocity ◽  
Cerebral Blood Flow Velocity ◽  
Small Fiber Neuropathy ◽  
Cerebral Hypoperfusion ◽  
Small Fiber ◽  
Receptor Antibodies

This patient exhibited tilt-induced orthostatic hypotension and reduced orthostatic cerebral blood flow velocity due to combined hypocapnic cerebral hypoperfusion (HYCH) and orthostatic cerebral hypoperfusion syndrome (OCHOS). The patient had small fiber neuropathy, and clinical workup revealed elevated acetylcholine receptor antibodies.

Case 22: Orthostatic Cerebral Hypoperfusion Syndrome in Anaphylaxis

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.

Case 30: Hypocapnic Cerebral Hypoperfusion with Paced Breathing

2019 ◽  
pp. 189-193
Author(s):  
Peter Novak
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Blood Flow Velocity ◽  
Cerebral Blood Flow Velocity ◽  
Cerebral Hypoperfusion ◽  
Shortness Of Breath ◽  
Paced Breathing ◽  
Cerebral Vasoconstriction ◽  
Patient Reported

In this patient, cerebral blood flow velocity (CBFv) was reduced by 38% during the tilt. Decline in CBFv was due to hypocapnia-induced cerebral vasoconstriction, typical for hypocapnic cerebral hypoperfusion (HYCH). Patient reported dizziness, shortness of breath, and confusion during the tilt. Blood pressure during tilt showed prominent oscillations characteristic of hypovolemia.

Case 55: Small Fiber Neuropathy with Autonomic Failure

2019 ◽  
pp. 298-302
Author(s):  
Peter Novak
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Orthostatic Hypotension ◽  
Flow Velocity ◽  
Blood Flow Velocity ◽  
Cerebral Blood Flow Velocity ◽  
Autonomic Failure ◽  
Small Fiber Neuropathy ◽  
Small Fiber ◽  
Adrenergic Fibers

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.

Abstract TP421: Cerebral Blood Flow Dynamics and Head-of-Bed Changes in the Setting of Subarachnoid Hemorrhage

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
David K Kung ◽  
Nohra Chalouhi ◽  
Pascal M Jabbour ◽  
Aaron S Dumont ◽  
H. R Winn ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Subarachnoid Hemorrhage ◽  
Flow Velocity ◽  
Thermal Diffusion ◽  
Blood Flow Velocity ◽  
Cerebral Blood Flow Velocity ◽  
Regional Blood Flow ◽  
Cerebral Hypoperfusion ◽  
Sitting Position

Background: Head-of-bed (HOB) elevation is usually restricted in patients with aneurysmal subarachnoid hemorrhage (SAH). This practice is believed to prevent cerebral hypoperfusion. Objective: The goal of this study is to correlate HOB changes (0 o and 90 o ) with cerebral blood flow using Trans-cranial Doppler (TCD) and thermal diffusion probe in SAH patients. Methods: Thirteen patients with SAH were prospectively enrolled in the study. Eight patients underwent placement of a thermal diffusion probe for regional CBF measurement in the same setting when placing a ventriculostomy. CBF values were measured by TCD alone (13 subjects) or concurrently with thermal diffusion probe (8 subjects) with the patients in a flat (0 o ) and upright sitting position (90 o ) at day 3, 7, and 10. Results: The average increase in blood flow velocity when changing HOB from 0 o to 90 o was 7.8% on day 3, 0.1% on day 7, and 13.1% on day 10. The middle cerebral artery had the least changes in velocity compared to the anterior cerebral and the posterior cerebral arteries. The average regional CBF measurement was 22.7 +/- 10.3 ml/100g/min in the supine position and 23.6 +/- 9.1 mg/100g/min in the sitting position. The changes were not statistically significant. No change in clinical exam was appreciated. None of the patients developed clinical cerebral vasospasm. Conclusion: Changing HOB position in the setting of SAH did not significantly affect either cerebral blood flow velocity or regional blood flow. This data suggests that early mobilization should be considered given the detrimental effects of prolonged bed rest.

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