Disparate cardio-cerebral vascular modulation during standing in multiple system atrophy and Parkinson disease.
OBJECTIVE
The dynamic variance of cerebral blood flow velocity (CBFV), monitored by transcranial doppler (TCD), can reveal the integrated effects of cardio-cerebral vascular autoregulation. We investigated the characteristics of CBFV curve during active standing in multiple system atrophy (MSA), Parkinson's disease (PD) and healthy volunteers.


METHODS
The CBFV curve of middle cerebral arteries was recorded using TCD in 22 patients with probable MSA; 20 PD patients and 20 volunteers matched for age. All individuals started in a supine posture, followed by abrupt standing for 2 min before returning to supine. The features of CBFV curve were compared among the groups.


RESULTS
In the healthy volunteers, the CBFV decreased following standing up but quickly rebounded and reached the same or greater level as the supine baseline. Afterwards, the CBFV decreased abruptly to a sustained level, lower than the supine baseline, forming a spike wave that appeared in CBFV curve. This spike wave was present in 5/22 of MSA, significantly less than PD patients (18/20) and volunteers (20/20) (P<0.001). The CBFV decrease after standing showed no significant difference between MSA than PD (9+/-7 vs. 6+/-3 cm/s, P=0.163).


CONCLUSIONS
The different pattern of CBFV curves during active standing suggests MSA may possess cardio-cerebral vascular modulation different from PD. The clinical value of the CBFV curve in differentiating MSA from PD needs further investigation.
Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Shuaifuyuan 1, Beijing, China. xuwhpumch@yahoo.com.cn
Wei-Hai
WH
Xu
Han
H
Wang
Bo
B
Wang
Fu-Sheng
FS
Niu
Shan
S
Gao
Li-Ying
LY
Cui
D001783:Blood Flow Velocity / Q000502:physiology; D001921:Brain / Q000503:physiopathology; D016022:Case-Control Studies; D002560:Cerebrovascular Circulation / Q000502:physiology*; D016009:Chi-Square Distribution; D006801:Humans; D019578:Multiple System Atrophy / Q000000981:diagnostic imaging / Q000503:physiopathology*; D017711:Nonlinear Dynamics; D010300:Parkinson Disease / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011187:Posture / Q000502:physiology*; D012189:Retrospective Studies; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods