title: Vasomotor reactivity as a predictor for syncope in patients with orthostatism.
abstract: OBJECTIVE
  Syncope in patients with orthostatic hypotension (OH) may be the result of impaired cerebral autoregulation. Cerebral autoregulation status can be determined by assessing cerebral vasomotor reactivity (VMR). We assessed and compared VMR in patients with OH with and without syncope.
  
  
  METHODS
  Twenty-nine patients with OH underwent transcranial Doppler (TCD) and the Diamox test (1 g acetazolamide IV) for assessing VMR during elaboration of their OH syndrome. The percent difference between cerebral blood flow velocities (BFV) in the middle cerebral (MCA) and vertebral (VA) arteries before and after acetazolamide was defined as VMR%. We considered increases of BFV of ≥ 40% as being indicative of good VMR and classified our study patients as having good or impaired VMRs accordingly.
  
  
  RESULTS
  Mean VMR% values of the MCA and VA in patients with OH with syncope (n = 12) were significantly lower as compared with patients with OH without syncope (n = 17): 25.2 ± 20.5% and 42.5 ± 18.6%; 20.9 ± 15.5% and 40.8 ± 28.5%, respectively (P < 0.05).
  
  
  CONCLUSIONS
  Among patients with OH, we found an association between the presence of syncope and impaired VMR. Assessment of VMR among patients with OH may predict those who are at higher risk to faint and fall and to support more aggressive intervention.
authors.affiliation: The Department of Neurology, Barzilai Medical Center, Tel-Aviv, Israel.
authors.forename: A Y
authors.initials: AY
authors.lastname: Gur
authors.forename: E
authors.initials: E
authors.lastname: Auriel
authors.forename: A D
authors.initials: AD
authors.lastname: Korczyn
authors.forename: A
authors.initials: A
authors.lastname: Gadoth
authors.forename: L
authors.initials: L
authors.lastname: Shopin
authors.forename: N
authors.initials: N
authors.lastname: Giladi
authors.forename: N M
authors.initials: NM
authors.lastname: Bornstein
authors.forename: T
authors.initials: T
authors.lastname: Gurevich
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002560:Cerebrovascular Circulation / Q000502:physiology; D005260:Female; D006706:Homeostasis / Q000502:physiology*; D006801:Humans; D007024:Hypotension, Orthostatic / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D011237:Predictive Value of Tests; D013575:Syncope / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D014463:Ultrasonography; D014666:Vasomotor System / Q000000981:diagnostic imaging / Q000503:physiopathology*