Yu-Chien Tsao1, Chih-Ping Chung2, Hung-Yi Hsu3, Chun-Yu Cheng4, A-Ching Chao5, Wen-Yung Sheng6, Han-Hwa Hu7, Chen-Jee Hong8, Jaw-Ching Wu9. 1. Department of Internal Medicine, Yonghe Cardinal Tien Hospital, Taipei 234, Taiwan; Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei 11217, Taiwan; School of Medicine, National Yang-Ming University, Taipei 11217, Taiwan. 2. Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei 11217, Taiwan; School of Medicine, National Yang-Ming University, Taipei 11217, Taiwan. Electronic address: cpchung@vghtpe.gov.tw. 3. Department of Neurology, Tungs' Taichung Metro Harbor Hospital, Taichung 435, Taiwan; School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan. 4. School of Medicine, National Yang-Ming University, Taipei 11217, Taiwan; Internal Medicine Department, Cheng Hsin General Hospital, Taipei 112, Taiwan. 5. Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung 807, Taiwan. 6. Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei 11217, Taiwan. 7. Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei 11217, Taiwan; School of Medicine, National Yang-Ming University, Taipei 11217, Taiwan. 8. School of Medicine, National Yang-Ming University, Taipei 11217, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei 11217, Taiwan. 9. School of Medicine, National Yang-Ming University, Taipei 11217, Taiwan; Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
Abstract
OBJECTIVE: Panic disorder (PD) is characterized by panic attacks accompanied with respiratory symptoms. Internal jugular vein (IJV) alters its hemodynamics in response to respiration and which might cause cerebral blood flow (CBF) changes. In the present study, we compared (1) respiratory-related IJV hemodynamics and (2) CBF changes during Valsalva maneuver (VM) between PD and normal subjects. METHODS: 42 PD patients and age/gender-matched controls (14 men; 52.3 ± 11.4 years) were recruited. Duplex ultrasonography measured time-averaged mean velocity (TAMV) and lumen in IJV at baseline and deep inspiration. Lumen area <0.10 cm(2) at deep inspiration was defined as IJV collapse. CBF changes during VM were recorded by transcranial Doppler (TCD). RESULTS: Compared with normal group, PD patients had significantly higher frequency of IJV collapse at deep inspiration (Left: 40.0% vs. 7.0%, p = 0.0003, Right: 17.0% vs. 0%, p = 0.0119). IJV collapse was associated with symptoms of respiratory subtype in our PD patients. PD group also had smaller lumen (Left: 0.53 ± 0.29 vs. 0.55 ± 0.26 cm(2), p = 0.8296, Right: 0.63 ± 0.36 vs. 0.93 ± 0.45 cm(2), p = 0.0014) and slower TAMV of IJV at baseline (Left: 11.8 ± 8.43 vs. 20.6 ± 16.5 cm/s, p = 0.0003, Right: 15.9 ± 9.19 vs. 24.1 ± 15.7 cm/s, p = 0.0062). PD patients with inspiration-induced IJV collapse had more decreased CBF during VM compared with the other PD patients and normal individuals respectively. INTERPRETATION: We are the first to show that PD have less IJV flow at baseline and more frequent collapse at deep inspiration. Inspiration-induced IJV collapsed was associated with CBF decrement during VM in PD patients. These results suggest that venous drainage impairment might play a role in the pathophysiology of PD by influencing CBF.
OBJECTIVE:Panic disorder (PD) is characterized by panic attacks accompanied with respiratory symptoms. Internal jugular vein (IJV) alters its hemodynamics in response to respiration and which might cause cerebral blood flow (CBF) changes. In the present study, we compared (1) respiratory-related IJV hemodynamics and (2) CBF changes during Valsalva maneuver (VM) between PD and normal subjects. METHODS: 42 PDpatients and age/gender-matched controls (14 men; 52.3 ± 11.4 years) were recruited. Duplex ultrasonography measured time-averaged mean velocity (TAMV) and lumen in IJV at baseline and deep inspiration. Lumen area <0.10 cm(2) at deep inspiration was defined as IJV collapse. CBF changes during VM were recorded by transcranial Doppler (TCD). RESULTS: Compared with normal group, PDpatients had significantly higher frequency of IJV collapse at deep inspiration (Left: 40.0% vs. 7.0%, p = 0.0003, Right: 17.0% vs. 0%, p = 0.0119). IJV collapse was associated with symptoms of respiratory subtype in our PDpatients. PD group also had smaller lumen (Left: 0.53 ± 0.29 vs. 0.55 ± 0.26 cm(2), p = 0.8296, Right: 0.63 ± 0.36 vs. 0.93 ± 0.45 cm(2), p = 0.0014) and slower TAMV of IJV at baseline (Left: 11.8 ± 8.43 vs. 20.6 ± 16.5 cm/s, p = 0.0003, Right: 15.9 ± 9.19 vs. 24.1 ± 15.7 cm/s, p = 0.0062). PDpatients with inspiration-induced IJV collapse had more decreased CBF during VM compared with the other PDpatients and normal individuals respectively. INTERPRETATION: We are the first to show that PD have less IJV flow at baseline and more frequent collapse at deep inspiration. Inspiration-induced IJV collapsed was associated with CBF decrement during VM in PDpatients. These results suggest that venous drainage impairment might play a role in the pathophysiology of PD by influencing CBF.