title: [Quantitative tilt table study with TCD monitoring. A reliable method for the diagnosis of neurocardiogenic syncope (vasovagal syncope)].
abstract: The clinical significance of quantitative tilt-table examination with TCD monitoring in the diagnosis of neurocardiogenic syncope is evaluated. A 50-year-old male suffered a neurocardiogenic syncope during tilt-table examination with a strong drop in blood pressure, an increase in cerebrovascular resistance as evidenced by transcranial Doppler monitoring, and a 30-s cardiac asystole, followed by a generalized seizure. No further syncope could be elicited during tilt-table examination after beta-blocker treatment. It was hypothesized that hyperactivity of the left ventricular mechanoreceptors due to increased force of ventricular contraction during a state of reduced venous backstream to the heart was responsible for eliciting the neurocardiogenic syncope. Tilt-table examination with an upright position for at least 45 min enables the diagnosis of a neurocardiogenic syncope to be made with sufficient sensitivity and specificity. Several studies have shown that medication with beta-blockers is successful in the treatment of neurocardiogenic syncope. The implantation of cardiac pacemakers should only be considered if medication is not successful.
authors.affiliation: Neurologische Klinik mit Klinischer Neurophysiologie Alfried-Krupp-Krankenhaus, Essen.
authors.forename: R R
authors.initials: RR
authors.lastname: Diehl
authors.forename: P
authors.initials: P
authors.lastname: Berlit
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D001143:Arousal / Q000187:drug effects / Q000502:physiology; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D001921:Brain / Q000098:blood supply; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology; D006352:Heart Ventricles / Q000187:drug effects / Q000503:physiopathology; D006801:Humans; D008297:Male; D008465:Mechanoreceptors / Q000187:drug effects / Q000503:physiopathology; D008875:Middle Aged; D010138:Pacemaker, Artificial; D013575:Syncope / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D018667:Tilt-Table Test; D017585:Ultrasonography, Doppler, Transcranial; D014630:Vagus Nerve / Q000187:drug effects / Q000503:physiopathology*; D014655:Vascular Resistance / Q000187:drug effects / Q000502:physiology; D014666:Vasomotor System / Q000187:drug effects / Q000503:physiopathology*
chemical_list: D000319:Adrenergic beta-Antagonists
vernacular_title: Die quantitative Kipptischuntersuchung mit TCD-Monitoring. Eine reliable Methode zur Diagnose der neurokardiogenen Synkope (vasovagalen Synkope).