Document Detail


Autonomic nervous system function in chronic dizziness.
MedLine Citation:
PMID:  17514065     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The goals of this study were to validate the clinical diagnosis of autonomic dizziness as a cause of chronic nonvertiginous dizziness that may be exacerbated by physical exertion or orthostatic challenges, estimate its prevalence in a tertiary referral population, and investigate the usefulness of three autonomic challenges as objective tests for this condition. STUDY DESIGN: Laboratory investigation of autonomic activity. SETTING: Tertiary care balance center. PATIENTS: Fifteen men and women with symptoms indicative of autonomic dizziness. Subjects with other causes of dizziness, histories of syncope, or psychiatric disorders were excluded. INTERVENTIONS: Autonomic tests included 45 minutes of head upright tilt (HUT), 20 minutes of 5% CO2 inhalation and then HUT, and 2 minutes of voluntary hyperventilation and then HUT. MAIN OUTCOME MEASURES: Patterns of cardiovascular and respiratory responses and subjective ratings of dizziness, autonomic symptoms, and anxiety during autonomic challenges. RESULTS: Twelve subjects had evidence of autonomic dysfunction, including 10 with abnormal heart rate, blood pressure, or respiratory responses to HUT. Two other subjects had prolonged hypocarbia after voluntary hyperventilation. Many of these abnormalities would have been missed by current autonomic testing paradigms. In one subject, CO2 inhalation revealed latent anxiety. In two subjects, the presence of high symptom ratings without objective autonomic dysfunction prompted a successful search for other diagnoses. CONCLUSION: Study results validated the clinical syndrome of autonomic dizziness. Autonomic testing protocols may have to be updated to detect clinically relevant abnormalities in patients with dizziness.
Authors:
Jeffrey P Staab; Michael J Ruckenstein
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology     Volume:  28     ISSN:  1531-7129     ISO Abbreviation:  Otol. Neurotol.     Publication Date:  2007 Sep 
Date Detail:
Created Date:  2007-10-16     Completed Date:  2007-11-20     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  100961504     Medline TA:  Otol Neurotol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  854-9     Citation Subset:  IM    
Affiliation:
Department of Psychiatry, University of Pennsylvania Health System, Philadelphia, Pennsylvania 19104, USA. jeffrey.staab@uphs.upenn.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Autonomic Nervous System / physiopathology*
Autonomic Nervous System Diseases / complications*,  physiopathology*
Blood Pressure / physiology
Carbon Dioxide / diagnostic use
Chronic Disease
Dizziness / etiology*,  physiopathology*
Female
Heart Rate / physiology
Humans
Hyperventilation / physiopathology
Male
Middle Aged
Motion Sickness / physiopathology
Postural Balance / physiology
Posture / physiology
Respiratory Mechanics / physiology
Shy-Drager Syndrome / physiopathology
Supine Position / physiology
Tilt-Table Test
Chemical
Reg. No./Substance:
124-38-9/Carbon Dioxide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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