Autoregulation of cerebral blood flow in patients with orthostatic hypotension after spinal cord injury

F. Gonzalez, J. Y. Chang, K. Banovac, D. Messina, Alberto Martinez-Arizala, R. E. Kelley

Research output: Contribution to journalArticle

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Abstract

Two groups of patients who developed orthostatic hypotension (OH) after spinal cord injury (SCI) were studied. In the first group all patients (4 females and 6 males) were asymptomatic, whereas in the second group (1 female and 9 males) all had clinical manifestations of hypotension. All but 3 patients were tetraplegic, and these patients were paraplegic above the T6 level. For this study blood pressure (BP), heart rate and cerebral blood flow (CBF) velocity were measured simultaneously on a tilt table at 0, 30, 60, and 80 degrees. Cerebral blood flow in the middle cerebral artery was measured bilaterally utilising the transcranial Doppler technique. In asymptomatic patients the mean baseline (0 degrees) BP (110 ± 16/70 ± 77 mm Hg systolic/diastolic) was not significantly different from the BP (106 ± 16/68 ± 11 mm Hg) of symptomatic patients. The mean maximal change in BP during tilling in the asymptomatic group (-23 ± 10/10 ± 7 mm Hg) was also not significantly different when compared to the symptomatic group (-29 ± 13/11 ± 6 mm Hg). CBF in the symptomatic group during the hypotensive reaction at 80 degrees was 32.5 ± 5 cm/sec, while at the same body position in the asymptomatic group it was 40 9 ± 8 cm/sec (significant at the p < 0-02). In addition, CBF decreased in the symptomatic group at 80 degrees to 55-5 ± 9-6% of baseline, while in the asymptomatic group the fall was 69 3 ± 7-2% (p < 0'001). Our data suggests that autoregnlation of CBF rather than systemic BP plays a dominant role in the adaptation to OH in patients with SCI.

Original languageEnglish (US)
Pages (from-to)37-42
Number of pages6
JournalParaplegia
Volume29
Issue number1
DOIs
StatePublished - 1991

Fingerprint

Cerebrovascular Circulation
Orthostatic Hypotension
Spinal Cord Injuries
Homeostasis
Blood Pressure
Blood Flow Velocity
Middle Cerebral Artery
Hypotension
Heart Rate

Keywords

  • Cerebral blood flow
  • Orthostatic hypotension
  • Spinal cord injury

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Autoregulation of cerebral blood flow in patients with orthostatic hypotension after spinal cord injury. / Gonzalez, F.; Chang, J. Y.; Banovac, K.; Messina, D.; Martinez-Arizala, Alberto; Kelley, R. E.

In: Paraplegia, Vol. 29, No. 1, 1991, p. 37-42.

Research output: Contribution to journalArticle

Gonzalez, F. ; Chang, J. Y. ; Banovac, K. ; Messina, D. ; Martinez-Arizala, Alberto ; Kelley, R. E. / Autoregulation of cerebral blood flow in patients with orthostatic hypotension after spinal cord injury. In: Paraplegia. 1991 ; Vol. 29, No. 1. pp. 37-42.
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AB - Two groups of patients who developed orthostatic hypotension (OH) after spinal cord injury (SCI) were studied. In the first group all patients (4 females and 6 males) were asymptomatic, whereas in the second group (1 female and 9 males) all had clinical manifestations of hypotension. All but 3 patients were tetraplegic, and these patients were paraplegic above the T6 level. For this study blood pressure (BP), heart rate and cerebral blood flow (CBF) velocity were measured simultaneously on a tilt table at 0, 30, 60, and 80 degrees. Cerebral blood flow in the middle cerebral artery was measured bilaterally utilising the transcranial Doppler technique. In asymptomatic patients the mean baseline (0 degrees) BP (110 ± 16/70 ± 77 mm Hg systolic/diastolic) was not significantly different from the BP (106 ± 16/68 ± 11 mm Hg) of symptomatic patients. The mean maximal change in BP during tilling in the asymptomatic group (-23 ± 10/10 ± 7 mm Hg) was also not significantly different when compared to the symptomatic group (-29 ± 13/11 ± 6 mm Hg). CBF in the symptomatic group during the hypotensive reaction at 80 degrees was 32.5 ± 5 cm/sec, while at the same body position in the asymptomatic group it was 40 9 ± 8 cm/sec (significant at the p < 0-02). In addition, CBF decreased in the symptomatic group at 80 degrees to 55-5 ± 9-6% of baseline, while in the asymptomatic group the fall was 69 3 ± 7-2% (p < 0'001). Our data suggests that autoregnlation of CBF rather than systemic BP plays a dominant role in the adaptation to OH in patients with SCI.

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