Orthostatic hemodynamics in the vertebral artery and blood pressure in patients with orthostatic dizziness/vertigo

Yachiyo Matsumura; Toshiaki Yamanaka; Takayuki Murai; Nobuya Fujita; Tadashi Kitahara

doi:10.1016/j.anl.2021.12.002

Orthostatic hemodynamics in the vertebral artery and blood pressure in patients with orthostatic dizziness/vertigo

Auris Nasus Larynx. 2022 Aug;49(4):593-598. doi: 10.1016/j.anl.2021.12.002. Epub 2021 Dec 18.

Authors

Yachiyo Matsumura¹, Toshiaki Yamanaka², Takayuki Murai¹, Nobuya Fujita³, Tadashi Kitahara¹

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Nara Medical University School of Medicine Address: 840 Shijo, Kashihara Nara, 634-8522, Japan.
² Department of Otolaryngology-Head and Neck Surgery, Nara Medical University School of Medicine Address: 840 Shijo, Kashihara Nara, 634-8522, Japan.. Electronic address: toshya@naramed-u.ac.jp.
³ Department of Otorhinolaryngology, Osaka Kaisei Hospital, Address: 1-6-10 Miyahara, Yodogawa-ku, Osaka, 532-0003, Japan.

PMID: 34930632
DOI: 10.1016/j.anl.2021.12.002

Abstract

Objectives: Orthostatic dizziness/vertigo (ODV) is a common symptom and is believed to occur due to the cerebral hypoperfusion caused by orthostatic hypotension (OH). However, the detailed mechanism underlying ODV onset is poorly understood. The vertebral artery (VA) mainly supplies blood to the central vestibular system; therefore, the orthostatic decrease of VA blood flow could possibly lead to ODV. This study investigated the orthostatic blood pressure and VA hemodynamics in ODV patients to elucidate the hemodynamic mechanism underlying ODV onset. Furthermore, the influence of orthostatic hypotension (OH) on VA hemodynamics was examined because OH is probably the most common cause of ODV.

Methods: This study included 181 patients with ODV and 73 control patients without ODV. All subjects underwent an active standing test to measure the extracranial Doppler (ECD) sonography spectrum of the VA and blood pressure (BP). VA blood flow velocity and BP were simultaneously measured for each patient in the supine static position and then in the upright standing positions following 3 min of standing. We investigated the orthostatic change in the average of flow velocity in bilateral VAs (VAFV) and BP for ODV patients compared with the control patients.

Result: VAFV in ODV patients was significantly reduced when standing up compared with the control patients. In the ODV patients, there was no difference in orthostatic decrease in VAFV between patients those with OH and without OH. However, the VAFV in the standing position was significantly lower in patients with OH than without OH. In cases with OH, the ODV patients exhibited a greater decrease in VAFV compared with the control patients, but this was not statistically significant. In the absence of OH, a significantly greater orthostatic decrease in VAFV was observed in ODV patients compared with the controls.

Conclusion: Our findings suggest that the orthostatic decrease of VA blood flow is deeply involved in the hemodynamic mechanism underlying ODV onset and is possibly associated with OH and other etiologies.

Keywords: Extracranial doppler sonography; Orthostatic dizziness/vertigo; Orthostatic hypotension; Vertebral artery.

MeSH terms

Blood Pressure / physiology
Dizziness*
Hemodynamics / physiology
Humans
Hypotension, Orthostatic* / complications
Hypotension, Orthostatic* / diagnosis
Vertebral Artery / diagnostic imaging
Vertigo