Jinse Park1, Hee-Tae Kim2, Kang Min Park1, Sam Yeol Ha1, Sung Eun Kim1, Kyong Jin Shin1, Si Eun Kim1, Wooyoung Jang3, Ji Sun Kim4, Jinyoung Youn5, Engsoek Oh6, Suyeon Park7. 1. Department of Neurology, Haeundae Paik Hospital, Inje University, Busan, Republic of Korea. 2. Department of Neurology, Hanyang University College of Medicine, Hanyang University, College of Medicine, Seoul, Republic of Korea. 3. Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea. 4. Department of Neurology, Soonchunhyang University College of Medicine, Seoul, Republic of Korea. 5. Department of Neurology, Samsung Medical Center, College of Medicine Sungkyunkwan University, Seoul, Republic of Korea. 6. Department of Neurology, Chungnam National University Hospital, College of Medicine, Daejun, Republic of Korea. 7. Department of Biostatistics, Soonchunhyang University Hospital, Seoul, Republic of Korea.
Abstract
OBJECTIVES: 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.
OBJECTIVES: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 PDpatients, using transcranial Doppler monitoring during head-up tilting. METHODS: Forty-five PDpatients with dizziness, 13 PDpatients 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 PDpatients despite a lack of OH. Transcranial Doppler monitoring during head-up tilting may be a useful tool for evaluating dizziness in PDpatients with or without OH.