title: Orthostatic dizziness in Parkinson's disease is attributed to cerebral hypoperfusion: A transcranial doppler study.
abstract: OBJECTIVE
  Orthostatic hypotension (OH) is controversially regarded as the cause of orthostatic dizziness in Parkinson's disease (PD). We sought to evaluate whether cerebral autoregulation is an alternative cause for orthostatic dizziness in PD patients, using transcranial Doppler monitoring during head-up tilting.
  
  
  METHODS
  Forty-five PD patients with dizziness, 13 PD patients without dizziness, and 10 age-matched healthy controls were enrolled. Participants were divided into the following four groups: patients with dizziness and OH (group 1, n = 22), patients with dizziness but no OH (n = 23, group 2), patients without dizziness (n = 11, group 3), and age-matched healthy controls (n = 10, group 4). All participants underwent transcranial Doppler and blood pressure monitoring for 10 minutes during the head-up tilt test. Changes in the cerebral blood flow velocity (CBFV) in the middle cerebral artery and the mean blood pressure (mBP) within 3 minutes after head-up tilting were compared between groups.
  
  
  RESULTS
  Group 1 showed a significantly higher change in mBP (-16.3 ± 10.8 mmHg) than groups 2 (-2.6 ± 4.9), 3 (-2.2 ± 3.6), or 4 (1.8 ± 6.0) (p < 0.001). However, groups 3 (4.6 ± 3.0 cm/s) and 4 (-4.2 ± 2.5) showed a significantly smaller change in CBFV than groups 1 (-9.0 ± 4.2) and 2 (-8.1 ± 5.1) (p < 0.01).
  
  
  CONCLUSIONS
  Our results suggest that cerebral hypoperfusion contributes to dizziness in PD patients despite a lack of OH. Transcranial Doppler monitoring during head-up tilting may be a useful tool for evaluating dizziness in PD patients with or without OH. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:337-342, 2017.
authors.affiliation: Department of Neurology, Haeundae Paik Hospital, Inje University, Busan, Republic of Korea.
authors.forename: Jinse
authors.identifier: http://orcid.org/0000-0001-8738-5422
authors.initials: J
authors.lastname: Park
authors.affiliation: Department of Neurology, Hanyang University College of Medicine, Hanyang University, College of Medicine, Seoul, Republic of Korea.
authors.forename: Hee-Tae
authors.initials: HT
authors.lastname: Kim
authors.affiliation: Department of Neurology, Haeundae Paik Hospital, Inje University, Busan, Republic of Korea.
authors.forename: Kang Min
authors.initials: KM
authors.lastname: Park
authors.affiliation: Department of Neurology, Haeundae Paik Hospital, Inje University, Busan, Republic of Korea.
authors.forename: Sam Yeol
authors.initials: SY
authors.lastname: Ha
authors.affiliation: Department of Neurology, Haeundae Paik Hospital, Inje University, Busan, Republic of Korea.
authors.forename: Sung Eun
authors.initials: SE
authors.lastname: Kim
authors.affiliation: Department of Neurology, Haeundae Paik Hospital, Inje University, Busan, Republic of Korea.
authors.forename: Kyong Jin
authors.initials: KJ
authors.lastname: Shin
authors.affiliation: Department of Neurology, Haeundae Paik Hospital, Inje University, Busan, Republic of Korea.
authors.forename: Si Eun
authors.initials: SE
authors.lastname: Kim
authors.affiliation: Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea.
authors.forename: Wooyoung
authors.initials: W
authors.lastname: Jang
authors.affiliation: Department of Neurology, Soonchunhyang University College of Medicine, Seoul, Republic of Korea.
authors.forename: Ji Sun
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Neurology, Samsung Medical Center, College of Medicine Sungkyunkwan University, Seoul, Republic of Korea.
authors.forename: Jinyoung
authors.initials: J
authors.lastname: Youn
authors.affiliation: Department of Neurology, Chungnam National University Hospital, College of Medicine, Daejun, Republic of Korea.
authors.forename: Engsoek
authors.initials: E
authors.lastname: Oh
authors.affiliation: Department of Biostatistics, Soonchunhyang University Hospital, Seoul, Republic of Korea.
authors.forename: Suyeon
authors.initials: S
authors.lastname: Park
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002560:Cerebrovascular Circulation / Q000502:physiology*; D003430:Cross-Sectional Studies; D004244:Dizziness / Q000503:physiopathology*; D005260:Female; D006706:Homeostasis / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D010300:Parkinson Disease / Q000503:physiopathology*; D012189:Retrospective Studies; D018667:Tilt-Table Test; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods*
keywords: Parkinson's disease; cerebral autoregulation; orthostatic hypotension