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[Value of transcranial Doppler sonography during tilt table test in children]
H Eberhardt1, R Fölsing, R Herterich
1Kinderkrankenhaus St. Marien, Landshut, Germany. heieb@ngi.de
Insights
Neurocardiogenic syncope in children shows distinct middle cerebral artery blood flow changes before fainting. Transcranial Doppler (TCD) monitoring during tilt table tests can identify these changes, aiding in predicting and preventing syncope.
Area of Science:
- Pediatric Neurology
- Cardiology
- Neuroimaging
Background:
- Syncope is a common clinical issue in children.
- Neurocardiogenic syncope is a frequent cause of fainting in pediatric patients.
- Understanding the hemodynamic changes preceding syncope is crucial for diagnosis and management.
Purpose of the Study:
- To investigate the time-related and characteristic changes in middle cerebral artery blood flow velocity during tilt table testing in children.
- To assess the utility of transcranial Doppler sonography in identifying these hemodynamic alterations before syncope.
Main Methods:
- Tilt table tests were conducted on 40 pediatric patients with a history of syncope.
- Transcranial Doppler (TCD) was used to measure middle cerebral artery blood flow velocity.
- Electrocardiogram and blood pressure were monitored throughout the 70-degree postural test.
Main Results:
- Syncope occurred in 13 children (10 with neurocardiogenic syncope) after an average of 23.3 minutes.
- Initially, diastolic and mean middle cerebral artery blood flow velocity increased, while resistance and pulsatility index decreased.
- Immediately preceding syncope, a dramatic decrease in diastolic blood flow velocity was observed, often to undetectable levels.
Conclusions:
- Neurocardiogenic syncope in children is associated with characteristic middle cerebral artery blood flow velocity changes before loss of consciousness.
- Transcranial Doppler is a valuable tool for monitoring these changes during tilt table tests.
- Identifying these TCD patterns can potentially help prevent impending syncope in children.
Aim:
Transcranial Doppler sonography was used to asses time relation and characteristically changes in middle cerebral artery blood flow velocity before syncope during tilt table test in children.
Method:
We performed tilt table tests in 40 pediatric patients with a medical history for syncope after exclusion of neurologic and cardiologic diseases. Examination was done in a 70 degrees postural position under control of electrocardiogram, blood pressure measurement and measurements of blood flow velocity of middle cerebral artery by transcranial Doppler with 3-MHz probe.
Results:
In 13 children syncope occurred after 5 to 45 min (average 23.3). 10 of them were neurocardiogenic syncopes. With it diastolic and medium blood flow velocity of middle cerebral artery initial ever increased while resistance and pulsatility index decreased. Just before syncope the diastolic blood flow velocity decreased dramatically thus no diastolic blood flow could be measured, respectively. Almost we could measure no diastolic blood flow just before syncope occurred.
Conclusion:
Patients with neurocardiogenic syncope do have characteristically blood flow velocity changes of middle cerebral artery just before loosing consciousness. Transcranial Doppler is a usefully examination during tilt table. Clear transcranial Doppler results can help to prevent children from the impending syncope.