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Cerebral blood flow of children with vasovagal syncope

  • Barsan Tugba (a1), Kilic Zubeyir (a1), Uzuner Nevzat (a2), Yildirim Ali (a1), Ucar Birsen (a1) and Demir Tevfik (a1)...


Introduction: We aimed to evaluate changes in the cerebral blood supply in children during vasovagal syncope and to clarify the diagnostic value of transcranial Doppler for vasovagal syncope. Materials and methods: Patients were divided into three groups. Group 1 consisted of 31 patients who were symptomatic and whose head-up tilt test was positive. Group 2 comprised 21 patients who were symptomatic but whose tilt test was negative. Group 3 included 22 healthy children. For the diagnosis of vasovagal syncope, the tilt test was applied. For the subjects of the patient and control groups, the tilt test was repeated. The flow rates of bilateral middle cerebral arteries were continuously and simultaneously recorded with temporal window transcranial Doppler. Results: There were no statistically significant differences between the three groups with respect to age and gender distribution (p>0.05). When the bed was at an upright position, the maximum blood flow rate of the right middle cerebral artery was lower in Group 1 than in Group 2, although the decrease was more significant in comparison to the healthy control group (p<0.05). The minimum blood flow rate of the right middle cerebral artery was lower in Group 1 than the Group 2, although the decrease was more significant in comparison with the healthy control group (p<0.05). The maximum blood flow rate of the left middle cerebral artery was significantly lower in Group 1 than in the control group (p<0.05). Conclusion: Minimum and maximum blood flow rates are significantly decreased in patients tilt test (+) patients with vasovagal syncope during orthostatic stress.


Corresponding author

Correspondence to: Y. Ali, Department of Pediatric Cardiology, Eskisehir Osmangazi University, Eskisehir 26480, Turkey. Tel: 0902222392979; Fax: 0902222395400; E-mail:


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1. Myung, K. Park Pediatric Cardiology for Practitioners, 5th edn. Mosby Elsevier, Philadelphia, 2008.
2. Mcload, KA. Syncope in childhood. Arch Dis Child 2003; 88: 350353.
3. Driscoll, DJ, Jacobsen, SJ, Porter, CJ. Syncope in children and adolescents. J Am Coll Cardiol 1997; 29: 10391045.
4. Schondorf, R, Benoit, J, Wein, T. Cerebrovascular and cardiovascular measurements during neurally mediated syncope induced by head-up tilt. Stroke 1997; 28: 15641568.
5. Albina, G, Cisneros, LA, Laino, R, et al. Transcranial Doppler monitoring during head upright tilt table testing in patients with suspected neurocardiogenic syncope. Europace 2004; 6: 6369.
6. Strandgaard, S, Olesen, J, Skinhoj, E, Lasson, NA. Autoregulation of brain circulation in severe arterial hypertension. Br Med J 1973; 1: 507510.
7. Schondorf, R, Stein, R, Roberts, R, Benoit, J, Cupples, W. Dynamic cerebral autoregulation is preserved in neurally mediated syncope. J Appl Physiol 2001; 91: 24932502.
8. Sung, RYT, Du, ZD, Yu, CW, Yam, MC, Fok, TF. Cerebral blood flow during vasovagal syncope induced by active standing or head up tilt. Arch Dis Child 2000; 82: 154158.
9. Grubb, BP, Samoil, D, Kosinski, D. Cerebral syncope: loss of consciousness associated with cerebral vasoconstriction in the absence of systemic hypotension. Pacing Clin Electrophysiol 1998; 21: 652658.
10. Hugh, D. Moss and Adam’s Heart Disease in Infants, Children and Adolescents, 7th edn. Lippincott Williams & Wilkins, Philadelphia, 2008.
11. Sheldon, R, Killam, S. Methodology of isoproterenol-tilt table testing in patients with syncope. J Am Coll Cardiol 1992; 19: 773779.
12. Zhang, QY, Du, JB, Li, WZ. A study on the clinical characteristics and follow-up of postural orthostatic tachycardia syndrome in children. Zhanghua Er Ke Za Zhi 2005; 43: 165169.
13. Wen, C, Wang, C, Li, W, et al. Clinical analysis of vasovagal syncope in children. Zhangguo Dang Dai Er Ke Za Zhi 2010; 12: 723725.
14. Gajek, J, Zyśko, D, Mazurek, W. Efficacy of tilt training in patients with vasovagal syncope. Kardiyol Pol 2006; 64: 602608.
15. McGavigan, AD, Hood, S. The influence of sex and age on response to head-up tilt-table testing in patients with recurrent syncope. Age Ageing 2001; 30: 295298.
16. Raviele, A, Menozzi, C, Brignole, M, Gasparini, G, Alboni, P, Musso, G. Value of head-up tilt testing potentiated with sublingual nitroglycerin to assess the origin of unexplained syncope. Am J Cardiol 1995; 76: 267272.
17. Benditt, DG, Lurie, KG, Adler, SW, Sakaguchi, SW. Rationale and methodology of head-up tilt table testing for evaluation of neurally mediated (cardioneurogenic) syncope. In: Zipes DP, Jalife J (eds). Cardiac Electrophysiology: From Cell to Bedside. WB Saunders, Philadelphia, 1995, pp 11151128.
18. Zaidi, A, Benitez, D, Gaydecki, PA, Vohra, A, Fitzpatrick, AP. Haemodynamic efects of increasing angle of head up tilt. Heart 2000; 83: 181184.
19. Matalon, SV, Fahri, LE. Cardiopulmonary readjustments in passive tilt. J Appl Physiol 1979; 47: 503507.
20. Voice, RA, Lurie, KG, Sakaguchi, S. Comparison of tilt angles and provocative agents (edrophonium and isoproterenol) to improve head-upright tilt-table testing. Am J Cardiol 1998; 81: 346350.
21. Abi-Samra, F, Maloney, JD, Fouad-Tarazi, FM, Castle, LW. The usefulness of head-up tilt testing and hemodynamic investigations in the work up of syncope of unknown origin. Pacing Clin Electrophysiol 1988; 11: 12021214.
22. Aydın, MA, Salukhe, JV, Wilke, I, Willems, S. Management and therapy of vasovagal syncope. World J Cardiol 2010; 2: 308315.
23. DeMey, C, Enterling, D. Assessment of the hemodynamic responses to single passive head-up tilt by non-invasive methods in normotensive subjects. Methods Find Exp Clin Pharmacol 1986; 8: 449457.
24. Fitzpatrick, A, Theodorakis, G, Varda, P. The incidence of malignant vasovagal syndrome in patients with recurrent syncope. Eur Heart J 1991; 12: 389394.
25. Aaslid, R, Markwalder, T, Nomes, H. Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries. J Neurosurg 1982; 57: 769774.
26. Tiecks, FP, Lam, AM, Aaslid, R, Newell, D. Comparison of static and dynamic cerebral autoregulation measurements. Stroke 1995; 26: 10141019.
27. Carey, BJ, Manktelow, BN, Panerai, RB, Potter, JF. Cerebral autoregulatory responces to head-up tilt in normal subjects and patients with recurrent vasovagal syncope. Circulation 2001; 104: 898902.
28. Stephenson, JBP. Specific syncopes and anoxic seizure types. In: Stephenson JBP (ed.). Fits and Faints. Mackeith Press, London, 1990, pp 6770.



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