HEAD-UPRIGHT TILT-TABLE TESTING - A USEFUL TOOL IN THE EVALUATION AND MANAGEMENT OF RECURRENT VERTIGO OF UNKNOWN ORIGIN ASSOCIATED WITH NEAR-SYNCOPE OR SYNCOPE

被引:24
作者
GRUBB, BP [1 ]
RUBIN, AM [1 ]
WOLFE, D [1 ]
TEMESYARMOS, P [1 ]
HAHN, H [1 ]
ELLIOTT, L [1 ]
机构
[1] MED COLL OHIO,DEPT MED,DIV CARDIOVASC DIS,ELECTROPHYSIOL SECT,TOLEDO,OH 43699
关键词
D O I
10.1177/019459989210700410
中图分类号
R76 [耳鼻咽喉科学];
学科分类号
100213 ;
摘要
Recurrent idiopathic vertigo associated with near-syncope and syncope is a common perplexing problem, some cases of which are considered autonomically mediated (vasovagal). Upright-tilt-table testing has emerged as a potential method to test for vasovagal episodes. This study evaluated the use of this technique in the evaluation and management of patients with recurrent idiopathic vertigo associated with near-syncope or syncope. Twenty-one patients with recurrent unexplained vertigo and syncope/near-syncope and 11 control subjects were evaluated by use of an upright-tilt-table test for 30 minutes, with or without a graded isoproterenol infusion (1 to 4 mug/min given intravenously), in an attempt to provoke hypotension, bradycardia, or both, which reproduced the patient's symptoms. The patients included 10 men and 11 women (mean age, 51 +/- 16 years). Eleven controls with no history of vertigo were also studied. Transcranial Doppler sonography was used to assess cerebral arteriolar blood flow during tilt. All tilt-positive patients were placed on therapy with either beta-blockers, disopyramide, or transdermal scopolamine, the effectiveness of which was determined with another tilt-table study. Symptoms occurred in seven patients (33%) during the baseline tilt and in eight patients (38%) during isoproterenol infusion (total positives, 71%). Transcranial Doppler sonography demonstrated a 225% +/- 192% increase in pulsatility index and a 70% +/- 29% increase in resistance index (indicative of cerebral arteriolar vasoconstriction) at the time of vertigo. No control subject experienced syncope during this test. Each tilt-positive patient eventually became tilt-negative with therapy, and over a mean follow-up period of 26 months, no further episodes have occurred. We conclude that head-upright tilt-table testing may be a valuable tool in the evaluation of recurrent idiopathic vertigo associated with near-syncope or syncope and in the evaluation of pharmacotherapy.
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页码:570 / 576
页数:7
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