title: Head-upright tilt-table testing: a useful tool in the evaluation and management of recurrent vertigo of unknown origin associated with near-syncope or syncope.
abstract: Recurrent idiopathic vertigo associated with near-syncope and syncope is a common perplexing problem, some cases of which are considered autonomically mediated (vasovagal). Upright-tilt-table testing has emerged as a potential method to test for vasovagal episodes. This study evaluated the use of this technique in the evaluation and management of patients with recurrent idiopathic vertigo associated with near-syncope or syncope. Twenty-one patients with recurrent unexplained vertigo and syncope/near-syncope and 11 control subjects were evaluated by use of an upright-tilt-table test for 30 minutes, with or without a graded isoproterenol infusion (1 to 4 micrograms/min given intravenously), in an attempt to provoke hypotension, bradycardia, or both, which reproduced the patient's symptoms. The patients included 10 men and 11 women (mean age, 51 +/- 16 years). Eleven controls with no history of vertigo were also studied. Transcranial Doppler sonography was used to assess cerebral arteriolar blood flow during tilt. All tilt-positive patients were placed on therapy with either beta-blockers, disopyramide, or transdermal scopolamine, the effectiveness of which was determined with another tilt-table study. Symptoms occurred in seven patients (33%) during the baseline tilt and in eight patients (38%) during isoproterenol infusion (total positives, 71%). Transcranial Doppler sonography demonstrated a 225% +/- 192% increase in pulsatility index and a 70% +/- 29% increase in resistance index (indicative of cerebral arteriolar vasoconstriction) at the time of vertigo. No control subject experienced syncope during this test. Each tilt-positive patient eventually became tilt-negative with therapy, and over a mean follow-up period of 26 months, no further episodes have occurred.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Medical College of Ohio, Toledo 43699.
authors.forename: B P
authors.initials: BP
authors.lastname: Grubb
authors.forename: A M
authors.initials: AM
authors.lastname: Rubin
authors.forename: D
authors.initials: D
authors.lastname: Wolfe
authors.forename: P
authors.initials: P
authors.lastname: Temesy-Armos
authors.forename: H
authors.initials: H
authors.lastname: Hahn
authors.forename: L
authors.initials: L
authors.lastname: Elliott
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007545:Isoproterenol; D008297:Male; D008875:Middle Aged; D010036:Otolaryngology / Q000379:methods; D011187:Posture; D012008:Recurrence; D013575:Syncope / Q000150:complications*; D014717:Vertigo / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D007545:Isoproterenol