Cerebral ischemia in patients with orthostatic syncope--the significance of orthostatic hypotension and large vessel disease in the cervical and intracranial region]

We performed 90 degrees head-up tilting test for 10 minutes in 100 patients (66 men and 34 women) aged 50 years or more suffering from transient orthostatic syncope and measured their systolic blood pressure. Orthostatic hypotension (OH) was found in 51 patients, predominantly in men (38 cases). OH was complicated by large vessel disease (LV) as shown by MR angiography or carotid artery ultrasonography in 19 cases (37.3%). Progressive cerebral ischemia was found more frequently in patients with both OH and LV than in those with OH alone. Within the patients with OH alone, the drop in orthostatic blood pressure was greater in cases where progressive cerebral ischemia was present. In patients with both OH and LV, the minimum orthostatic systolic blood pressure was lower in those with progressive cerebral ischemia. These facts show that the marked drop in orthostatic blood pressure may be related to cerebral ischemic lesions and that the combination of OH and LV may develop cerebral ischemia in older patients with transient orthostatic syncope.