The Use of Transcranial Doppler during Tilt Table Testing in Children Presenting with Syncope

2007 ◽  
Vol 31 (2) ◽  
pp. 81-86 ◽  
Author(s):  
Heather A. Nicoletto ◽  
Mark W. Ellis ◽  
Daniel T. Laskowitz ◽  
Ronald J. Kanter ◽  
April E. Perry ◽  
...  
Keyword(s):  
Transcranial Doppler ◽  
Psychiatric Treatment ◽  
Cerebral Arteries ◽  
Tilt Table Test ◽  
Tilt Table ◽  
Multimodal Monitoring ◽  
Neurally Mediated Syncope ◽  
Middle Cerebral Arteries ◽  
Tilt Table Testing ◽  
Flow Velocities

Childhood syncope is common, and there are three categories of causes of syncope: noncardiovascular pseudosyncope, cardiovascular syncope, and neurally mediated syncope. Tilt table testing has become a valuable tool in the evaluation for the cause of syncope in children. Adding transcranial Doppler (TCD) to the tilt table test to monitor the middle cerebral arteries (MCA) adds valuable information about the cerebral blood flow during a syncopal episode and can help the physician differentiate between the various causes of syncope. Three children with frequent syncopal episodes were evaluated using tilt table testing with multimodal monitoring, including TCD. One child, during her syncopal episode, had an increase in blood pressure, heart rate, and MCA flow velocities. This finding was consistent with noncardiovascular pseudosyncope, and she was sent for psychiatric treatment. The other two patients had hypotension, bradycardia, a significant decrease in MCA flow velocities, and an increase in pulsatility indices. Additionally, one of them experienced a 6-sec period of asystole. Both were diagnosed with neurally mediated syncope and were placed on fludrocortisone and a water and salt regimen.

scholarly journals Brain Circulation during Panic Attack: A Transcranial Doppler Study with Clomipramine Challenge

2014 ◽  
Vol 2014 ◽  
pp. 1-6
Author(s):  
Francesco Rotella ◽  
Marinella Marinoni ◽  
Francesca Lejeune ◽  
Fabiana Alari ◽  
Daniela Depinesi ◽  
...  
Keyword(s):  
Panic Disorder ◽  
Transcranial Doppler ◽  
Panic Attack ◽  
Cerebral Arteries ◽  
Mean Flow ◽  
Middle Cerebral Arteries ◽  
History Of ◽  
Drug Naïve ◽  
Left Middle ◽  
Flow Velocities

Introduction. Cerebral blood flow has been well studied in patients with panic disorder, but only few studies analyzed the mechanisms underlying the onset of a panic attack. The aim of the present study was to monitor the cerebral hemodynamics modifications during a panic attack.Materials and Methods. 10 panic disorder patients with recent onset, fully drug naïve, were compared to 13 patients with panic disorder with a previous history of treatment and to 14 controls. A continuous bilateral monitoring of mean flow velocities in right and left middle cerebral arteries was performed by transcranial Doppler. Clomipramine was chosen as challenge.Results. Eight out of 10 patients drug naïve and 6 control subjects out of 13 had a full blown panic attack during the test, whereas none of the patients with a history of treatment panicked. The occurrence of a panic attack was accompanied by a rapid decrease of flow velocities in both right and left middle cerebral arteries.Discussion. The bilateral acute decrease of mean flow velocity during a panic attack suggests the vasoconstriction of the microcirculation of deep brain structures perfused by middle cerebral arteries and involved in the so-called “fear circuitry,” thus suggesting that cerebral homeostatic dysfunctions seem to have a key role in the onset of a panic attack.

Carotid-Cavernous Fistula Treated with Detachable Balloon during Bilateral Transcranial Doppler Monitoring of Middle Cerebral Arteries

1992 ◽  
Vol 33 (2) ◽  
pp. 145-148 ◽  
Author(s):  
P. H. Nakstad ◽  
J. K. Hald ◽  
W. Sorteberg
Keyword(s):  
Carotid Artery ◽  
Transcranial Doppler ◽  
Cerebral Arteries ◽  
Carotid Cavernous Fistula ◽  
Detachable Balloon ◽  
Cavernous Fistula ◽  
Doppler Technique ◽  
Middle Cerebral Arteries

A traumatic carotid-cavernous fistula was closed with a silicone detachable balloon. Prior to the closure of the fistula, clinical and transcranial Doppler testing was performed in order to evaluate the consequences of a possible occlusion of the carotid artery. A newly developed Doppler technique with bilateral simultaneous velocity recordings of the middle cerebral arteries was useful during the procedure. The detachable balloon was effective in closing the fistula, but collapse of the balloon and the development of an extradural aneurysm was found at control examinations.

scholarly journals A Comparison of Regional Cerebral Blood Flow and Middle Cerebral Artery Blood Flow Velocities: Simultaneous Measurements in Healthy Subjects

1992 ◽  
Vol 12 (6) ◽  
pp. 1049-1054 ◽  
Author(s):  
Arve Dahl ◽  
David Russell ◽  
Rolf Nyberg-Hansen ◽  
Kjell Rootwelt
Keyword(s):  
Blood Flow ◽  
Healthy Subjects ◽  
Cerebral Arteries ◽  
Transcranial Doppler Ultrasound ◽  
Velocity Increase ◽  
Mental Activation ◽  
Middle Cerebral Arteries ◽  
Blood Flow Velocities ◽  
Perfusion Territory ◽  
Flow Velocities

Blood flow velocities were measured in both middle cerebral arteries (MCAs) of 36 healthy subjects using transcranial Doppler ultrasound. Measurements were first made using a hand-held probe. Velocities were then studied bilaterally with fixed probes under resting conditions and during simultaneous regional CBF (rCBF) measurements. A significant (p < 0.05) positive correlation was found between MCA flow velocities and rCBF in the estimated perfusion territory of this artery. The correlation coefficient was highest when the measurements were performed simultaneously (p < 0.001) or when velocities recorded with a hand-held probe were adjusted to take into account the significant velocity increase induced by the CBF study situation. The increased velocities during CBF measurements cannot be fully explained by the moderate but significant Pco2 increase. Other possible mechanisms are increased blood flow due to mental activation or MCA vasoconstriction secondary to stimulation of the sympathetic nervous system. The effect of mental activation and Pco2 differences should therefore be considered when comparing the results of repeated velocity and CBF measurements.

Transcranial Doppler Sonography in Children

1989 ◽  
Vol 4 (1_suppl) ◽  
pp. S68-S76 ◽  
Author(s):  
Harald Bode ◽  
Alec Eden
Keyword(s):  
Transcranial Doppler ◽  
Doppler Sonography ◽  
Extreme Values ◽  
Ductus Arteriosus ◽  
Cerebral Arteries ◽  
Transcranial Doppler Sonography ◽  
Stable State ◽  
Carbon Dioxide Partial Pressure ◽  
Arterial Blood ◽  
Flow Velocities

The blood flow velocities in the basal cerebral arteries can be recorded at any age by transcranial Doppler sonography. By a standardized examination technique, the vessel identification is reliable even without visual control of the site of the sample volume. A stable state of vigilance is necessary to obtain constant recordings. Age has a tremendous influence on the flow velocities. The velocities increase rapidly during the first weeks and reach their maximum around the sixth year of life. The influence of carbon dioxide partial pressure, gestational age, birth weight, hematocrit, and vigilance on the velocities has to be considered. Heart rate and arterial blood pressure are relevant only in cases of extreme values. The clinical applications of transcranial Doppler sonography cover diseases like patent ductus arteriosus, perinatal brain damage, increased intracranial pressure, cerebral malformations, brain death, and stenoses and occlusions of main cerebral arteries. The technique is helpful for control of certain therapies. A continuous recording technique has also been developed for this purpose. Care should be taken in deriving a prognosis from Doppler recordings. (J Child Neurol 1989;4:S68-S76).

Hormonal Responses During Tilt-Table Test in Neurally Mediated Syncope

1997 ◽  
Vol 79 (12) ◽  
pp. 1692-1695 ◽  
Author(s):  
George N. Theodorakis ◽  
Manolis Markianos ◽  
Efthimios G. Livanis ◽  
Elias Zarvalis ◽  
Panagiota Flevari ◽  
...  
Keyword(s):  
Tilt Table Test ◽  
Tilt Table ◽  
Hormonal Responses ◽  
Neurally Mediated Syncope
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