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Transcranial Doppler in autonomic testing: standards and clinical applications

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Abstract

When cerebral blood flow falls below a critical limit, syncope occurs and, if prolonged, ischemia leads to neuronal death. The cerebral circulation has its own complex finely tuned autoregulatory mechanisms to ensure blood supply to the brain can meet the high metabolic demands of the underlying neuronal tissue. This involves the interplay between myogenic and metabolic mechanisms, input from noradrenergic and cholinergic neurons, and the release of vasoactive substrates, including adenosine from astrocytes and nitric oxide from the endothelium. Transcranial Doppler (TCD) is a non-invasive technique that provides real-time measurements of cerebral blood flow velocity. TCD can be very useful in the work-up of a patient with recurrent syncope. Cerebral autoregulatory mechanisms help defend the brain against hypoperfusion when perfusion pressure falls on standing. Syncope occurs when hypotension is severe, and susceptibility increases with hyperventilation, hypocapnia, and cerebral vasoconstriction. Here we review clinical standards for the acquisition and analysis of TCD signals in the autonomic laboratory and the multiple methods available to assess cerebral autoregulation. We also describe the control of cerebral blood flow in autonomic disorders and functional syndromes.

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Fig. 1
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Figures reprinted from [39,40,41, 68]

Fig. 4

Image courtesy of Dr. Peter Novak

Fig. 5

Image courtesy of Dr. Peter Novak

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Authors and Affiliations

  1. Department of Neurology, New York University School of Medicine, New York, NY, USA

    Lucy Norcliffe-Kaufmann

  2. Department of Neurology, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Palmer 127, Boston, MA, 02215, USA

    Brahyan Galindo-Mendez, Ana-Lucia Garcia-Guarniz & Vera Novak

  3. Department of Neurology, Hospital Universitario Son Espases, Illes Balears, Spain

    Estibaliz Villarreal-Vitorica

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  1. Lucy Norcliffe-Kaufmann
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  2. Brahyan Galindo-Mendez
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  4. Estibaliz Villarreal-Vitorica
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  5. Vera Novak
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Correspondence to Lucy Norcliffe-Kaufmann.

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This study was supported by grants from the National Institutes of Health NINDS (U54-NS065736 to LN-K) and by NIH-NIDDK (R01-DK13902-01A2 to VN).

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L. Norcliffe-Kaufmann and B. Galindo-Mendez contributed equally to the manuscript.

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Norcliffe-Kaufmann, L., Galindo-Mendez, B., Garcia-Guarniz, AL. et al. Transcranial Doppler in autonomic testing: standards and clinical applications. Clin Auton Res 28, 187–202 (2018). https://doi.org/10.1007/s10286-017-0454-2

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