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Scheurich JA, Sim LA, Gonzalez CA, Weiss KE, Dokken PJ, Willette AT, Harbeck-Weber C. Gender Diversity Among Youth Attending an Intensive Interdisciplinary Pain Treatment Program. J Clin Psychol Med Settings 2024:10.1007/s10880-023-09997-7. [PMID: 38265699 DOI: 10.1007/s10880-023-09997-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 01/25/2024]
Abstract
Transgender and gender diverse (TGD) youth with chronic pain may be at unique risk for psychological distress and associated functional impairment, yet research on the intersection of chronic pain and gender identity is lacking. In a retrospective chart review of 491 participants admitted to a pediatric intensive interdisciplinary pain treatment (IIPT) program in the midwestern United States over an approximately 4-year period, 6.11% were TGD. TGD participants who completed the IIPT program reported significant and large improvements in anxiety, depression, pain catastrophizing, and functional ability. At baseline, TGD participants presented as more emotionally distressed and functionally impaired compared to age-matched, cisgender peers. When accounting for baseline scores, TGD participants who completed the IIPT program reported similar scores to cisgender peers at discharge, yet TGD youth were significantly less likely than cisgender peers to complete the IIPT program. Future directions and implications for clinical practice are discussed.
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Affiliation(s)
- Jennifer A Scheurich
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA.
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
| | - Leslie A Sim
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Cesar A Gonzalez
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - Karen E Weiss
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Peggy J Dokken
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Amber T Willette
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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De Simone R, Sansone M, Curcio F, Russo CV, Galizia G, Miele A, Stornaiuolo A, Piccolo A, Braca S, Abete P. Recurrent reflex syncope in idiopathic intracranial hypertension patient resolved after lumbar puncture: pathogenetic implications. BMC Neurol 2023; 23:416. [PMID: 37990305 PMCID: PMC10662480 DOI: 10.1186/s12883-023-03451-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/30/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Idiopathic intracranial hypertension is a disease characterized by increased intracranial cerebrospinal fluid volume and pressure without evidence of other intracranial pathology. Dural sinuses are rigid structures representing a privileged low-pressure intracranial compartment. Rigidity of dural sinus ensures that the large physiologic fluctuations of cerebrospinal fluid pressure associated with postural changes or to Valsalva effect cannot be transmitted to the sinus. An abnormal dural sinus collapsibility, especially when associated with various anatomical sinus narrowing, has been proposed as a key factor in the pathogenesis of idiopathic intracranial hypertension. This pathogenetic model is based on an excessive collapsibility of the dural sinuses that leads to the triggering of a self-limiting venous collapse positive feedback-loop between the cerebrospinal fluid pressure, that compresses the sinus, and the increased dural sinus pressure upstream, that reduces the cerebrospinal fluid reabsorption rate, increasing cerebrospinal fluid volume and pressure at the expense of intracranial compliance and promoting further sinus compression. Intracranial compliance is the ability of the craniospinal space to accept small volumetric increases of one of its compartments without appreciable intracranial pressure rise. In idiopathic intracranial hypertension, a condition associated with a reduced rate of CSF reabsorption leading to its volumetric expansion, a pathologically reduced IC precedes and accompanies the rise of ICP. Syncope is defined as a transient loss of consciousness due to a transient cerebral hypoperfusion characterized by rapid onset, short duration, and spontaneous complete recovery. A transient global cerebral hypoperfusion represents the final mechanism of syncope determined by cardiac output and/or total peripheral resistance decrease. There are many causes determining low cardiac output including reflex bradycardia, arrhythmias, cardiac structural disease, inadequate venous return, and chronotropic and inotropic incompetence. Typically, syncopal transient loss of consciousness is mainly referred to an extracranial mechanism triggering a decrease in cardiac output and/or total peripheral resistance. Conversely, the association of syncope with a deranged control of intracranial compliance related to cerebral venous outflow disorders has been only anecdotally reported. CASE PRESENTATION We report on a 57-year-old woman with daily recurrent orthostatic hypotension syncope and idiopathic intracranial hypertension-related headaches, which resolved after lumbar puncture with cerebrospinal fluid subtraction. CONCLUSIONS A novel mechanism underlying the triggering of orthostatic syncope in the presence of intracranial hypertension-dependent reduced intracranial compliance is discussed.
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Affiliation(s)
- Roberto De Simone
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, Headache Centre, University Federico II of Naples, Via S. Pansini, 5, Naples, 80131, Italy.
| | - Mattia Sansone
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, Headache Centre, University Federico II of Naples, Via S. Pansini, 5, Naples, 80131, Italy
| | - Francesco Curcio
- Department of Translational Medical Sciences, University Federico II of Naples, Naples, Italy
| | - Cinzia Valeria Russo
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, Headache Centre, University Federico II of Naples, Via S. Pansini, 5, Naples, 80131, Italy
| | - Gianluigi Galizia
- Department of Translational Medical Sciences, University Federico II of Naples, Naples, Italy
| | - Angelo Miele
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, Headache Centre, University Federico II of Naples, Via S. Pansini, 5, Naples, 80131, Italy
| | - Antonio Stornaiuolo
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, Headache Centre, University Federico II of Naples, Via S. Pansini, 5, Naples, 80131, Italy
| | - Andrea Piccolo
- Department of Translational Medical Sciences, University Federico II of Naples, Naples, Italy
| | - Simone Braca
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, Headache Centre, University Federico II of Naples, Via S. Pansini, 5, Naples, 80131, Italy
| | - Pasquale Abete
- Department of Translational Medical Sciences, University Federico II of Naples, Naples, Italy
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Oliveira PML, da Silva RMFL, Tonelli HDAF, Meira ZMA, Mota CDCC. Clinical and Autonomic Profile, and Modified Calgary Score for Children and Adolescents with Presumed Vasovagal Syncope Submitted to the Tilt Test. Arq Bras Cardiol 2023; 120:e20220543. [PMID: 37556654 PMCID: PMC10382152 DOI: 10.36660/abc.20220543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 03/01/2023] [Accepted: 04/05/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND In the pediatric population, syncope is mainly from vasovagal (VVS) origin. Its evaluation must be done by clinical methods, and the tilt test (TT) can contribute to the diagnosis. OBJECTIVES To analyze the clinical profile, Calgary and modified Calgary scores, response to TT and heart rate variability (HRV) of patients aged ≤ 18 years with presumed VVS. To compare the variables between patients with positive and negative responses to TT. METHOD Observational and prospective study, with 73 patients aged between 6 and 18 years, submitted to clinical evaluation and calculation of scores without previous knowledge of the TT. It was done at 70º under monitoring for HRV analysis. P-value < 0.05 was the statistical significance criterion. RESULTS Median age was 14.0 years; 52% of participants were female, 72 had Calgary ≥ -2 (mean 1.80), and 69 had modified Calgary ≥ -3 (mean 1.38). Prodromes were observed in 59 patients, recurrence in 50 and trauma in 19. The response to TT was positive in 54 participants (49 vasovagal, with 39 vasodepressor responses), with an increase in the low frequency (LF) component and a decrease in the high frequency (HF) component (p < 0,0001). In the supine position, LF was 33.6 in females and 47.4 in normalized units for males (p = 0.02). When applying the operating characteristic curve for positive TT, there was no statistical significance for HRV and scores. CONCLUSION Most children and adolescents with a presumed diagnosis of VVS presented a typical clinical scenario, with a Calgary score ≥ -2, and a predominant vasodepressor response to TT. Greater sympathetic activation was observed in the supine position in males. Calgary scores and sympathetic activation did not predict the response to TT.
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Affiliation(s)
- Pamela Michelle Leite Oliveira
- Universidade Federal de Minas GeraisBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
- Hospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteMGBrasilHospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
| | - Rose Mary Ferreira Lisboa da Silva
- Universidade Federal de Minas GeraisBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
- Hospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteMGBrasilHospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
| | - Henrique de Assis Fonseca Tonelli
- Universidade Federal de Minas GeraisBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
- Hospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteMGBrasilHospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
| | - Zilda Maria Alves Meira
- Universidade Federal de Minas GeraisBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
- Hospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteMGBrasilHospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
| | - Cleonice de Carvalho Coelho Mota
- Universidade Federal de Minas GeraisBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
- Hospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteMGBrasilHospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
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Idiopathic Intracranial Hypertension and Vascular Anomalies in Chiari I Malformation. Neurosurg Clin N Am 2023; 34:175-183. [DOI: 10.1016/j.nec.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Iser C, Arca K. Headache and Autonomic Dysfunction: a Review. Curr Neurol Neurosci Rep 2022; 22:625-634. [PMID: 35994191 DOI: 10.1007/s11910-022-01225-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW We explore the anatomy of the central and peripheral autonomic pathways involved in primary headache as well as the mechanisms for secondary headache associated with disorders of the autonomic nervous system. The prevalence and clinical presentation of cranial and systemic autonomic symptoms in these conditions will be discussed, with a focus on recent studies. RECENT FINDINGS Several small studies have utilized the relationship between headache and the autonomic nervous system to identify potential biomarkers to aid in diagnosis of migraine and cluster headache. Headache in postural orthostatic tachycardia syndrome (POTS) has also been further characterized, particularly in its association with orthostatic headache and spontaneous intracranial hypotension (SIH). This review examines the pathophysiology of primary and secondary headache disorders in the context of the autonomic nervous system. Mechanisms of headache associated with systemic autonomic disorders are also reviewed.
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Affiliation(s)
- Courtney Iser
- Department of Neurology, Mayo Clinic Scottsdale, Scottsdale, AZ, USA
| | - Karissa Arca
- Department of Neurology, Mayo Clinic Scottsdale, Scottsdale, AZ, USA.
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Lisboa da Silva RMF, Oliveira PML, Tonelli HAF, Alves Meira ZM, Mota CDCC. Neurally Mediated Syncope in Children and Adolescents: An Updated Narrative Review. Open Cardiovasc Med J 2022. [DOI: 10.2174/18741924-v16-e2205110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Syncope presents a proportion of up to 25% among children and adolescents and accounts for 0.9% of emergency room visits. Its most frequent aetiology is neurally mediated syncope, which includes vasovagal syncope and orthostatic hypotension. Up to 70% of the paediatric population with reflex syncope is female. There are usually precipitating factors and prodromes. This mini-review will discuss the particularities of the clinical presentation, diagnosis, modified Calgary score, indications and accuracy of the head-up tilt test, classification, and pathophysiology in four sequential phases. Prognostic data and the non-pharmacological and pharmacological approaches will also be reviewed and differences regarding reflex syncope in adults will be discussed.
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Lee HE, Lee DW. Vasovagal syncope with mild versus moderate autonomic dysfunction: a 13-year single-center experience. Clin Exp Pediatr 2022; 65:47-52. [PMID: 34082501 PMCID: PMC8743434 DOI: 10.3345/cep.2021.00052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 05/24/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND An adequate large-scale pediatric cohort based on nationwide administrative data is lacking in Korea. PURPOSE This study aimed to differentiate patients with VVS by autonomic dysfunction severity using the composite autonomic severity score (CASS) and compare the clinical manifestations and prognosis between patient subgroups. METHODS We retrospectively reviewed the medical records of 66 VVS patients divided into 3 groups by CASS. To compare the differences between these groups, we analyzed VVS type, triggers, prodromal symptoms, management of syncope, and prognosis between patients with mild versus moderate autonomic dysfunction. RESULTS Of our 66 patients with VVS, 41 had mild autonomic dysfunction (62.1%) and 25 had moderate autonomic dysfunction (37.9%). We found no significant intergroup differences in age, sex, inducible factor (P=0.172), prodromal symptoms, laboratory findings, head-up tilt test, type of syncope, or prognosis (P=0.154). CONCLUSION We found no evidence that autonomic dysfunction degree is affected by VVS characteristics, test findings, parameters, or prognosis; therefore, no further evaluations are needed to classify autonomic dysfunction severity.
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Affiliation(s)
- Han Eoul Lee
- Department of Pediatrics, Daegu Fatima Hospital, Daegu, Korea
| | - Dong Won Lee
- Department of Pediatrics, Daegu Fatima Hospital, Daegu, Korea
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Ghosh A, Tran YX, Grant L, Numan MT, Patel R, Butler IJ. Orthostatic Headaches Associated With Spontaneous Intracranial Hypotension and Autonomic Dysfunction-A Case Series in Young Patients. Child Neurol Open 2021; 8:2329048X211056709. [PMID: 34841005 PMCID: PMC8619734 DOI: 10.1177/2329048x211056709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 05/22/2021] [Accepted: 10/07/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Orthostatic headaches can be noted in spontaneous intracranial hypotension and orthostatic intolerance. We present a case series of young patients diagnosed with spontaneous intracranial hypotension and were treated for the same but subsequently developed orthostatic intolerance. Methods: We retrospectively reviewed charts for seven young patients with orthostatic headaches related to spontaneous intracranial hypotension and orthostatic intolerance. Results: Patients were diagnosed with spontaneous intracranial hypotension. Diagnosis was confirmed by identifying epidural contrast leakage and three of seven patients were noted to have early renal contrast excretion on computerized tomography myelography. Patients were treated with epidural blood patches. All patients showed persistent symptoms of autonomic dysfunction after treatment of spontaneous intracranial hypotension and orthostatic intolerance was confirmed with head-up tilt table test. Conclusions: Patients with spontaneous intracranial hypotension failing to improve following epidural blood patching should be evaluated for orthostatic intolerance.
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Affiliation(s)
- Ankita Ghosh
- Division of Child and Adolescent Neurology, University of Texas Health Science Center, Cincinnati, USA.,LeBonheur Children's Hospital, Memphis, USA
| | - Yen X Tran
- Division of Child and Adolescent Neurology, Baylor college of Medicine, Houston, USA
| | - Leon Grant
- Division of Child and Adolescent Neurology, Sutter Health Medical group, Sacramento, USA
| | - Mohammed T Numan
- Division of Pediatric Cardiology, University of Texas Health Science Center
| | - Rajan Patel
- Division of Pediatric Neuroradiology, University of Texas Health Science Center, Houston, USA
| | - Ian J Butler
- Division of Child and Adolescent Neurology, University of Texas Health Science Center, Cincinnati, USA
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Starling CT, Nguyen QBD, Butler IJ, Numan MT, Hebert AA. Cutaneous manifestations of orthostatic intolerance syndromes. Int J Womens Dermatol 2021; 7:471-477. [PMID: 34621961 PMCID: PMC8484984 DOI: 10.1016/j.ijwd.2021.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 02/05/2021] [Accepted: 03/05/2021] [Indexed: 11/27/2022] Open
Abstract
Dysautonomia refers to a group of autonomic nervous system disorders that affect nearly 70 million people worldwide. One subset of dysautonomia includes syndromes of orthostatic intolerance (OI), which primarily affect adolescents and women of childbearing age. Due to the variability in disease presentation, the average time from symptom onset to diagnosis of dysautonomia is 6 years. In general, there is a paucity of dermatological research articles describing patients with dysautonomia. The objective of this review is to summarize the existing literature on cutaneous manifestations in dysautonomia, with an emphasis on syndromes of OI. A PubMed database of the English-language literature (1970–2020) was searched using the terms “dysautonomia”, “orthostatic intolerance”, “cutaneous”, “skin”, “hyperhidrosis”, “hypohidrosis”, “sweat”, and other synonyms. Results showed that cutaneous manifestations of orthostatic intolerance are common and varied, with one paper citing up to 85% of patients with OI having at least one cutaneous symptom. Recognition of dermatological complaints may lead to an earlier diagnosis of orthostatic intolerance, as well as other comorbid conditions.
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Affiliation(s)
| | - Quoc-Bao D Nguyen
- Department of Dermatology, UTHealth McGovern Medical School at Houston, Houston, Texas
| | - Ian J Butler
- Department of Pediatrics, UTHealth McGovern Medical School at Houston, Houston, Texas
| | - Mohammed T Numan
- Department of Pediatrics, UTHealth McGovern Medical School at Houston, Houston, Texas
| | - Adelaide A Hebert
- Department of Dermatology, UTHealth McGovern Medical School at Houston, Houston, Texas.,Department of Pediatrics, UTHealth McGovern Medical School at Houston, Houston, Texas
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Zou R, Wang S, Li F, Lin P, Zhang J, Wang Y, Xu Y, Wang C. The Application of Head-Up Tilt Test to Diagnose Hemodynamic Type of Orthostatic Intolerance in Children Aged Between 3 and 5 Years. Front Pediatr 2021; 9:623880. [PMID: 33748043 PMCID: PMC7965941 DOI: 10.3389/fped.2021.623880] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/03/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: The head-up tilt test (HUTT) is a useful tool to assess autonomic function and to reproduce neurally mediated reflex. In this study, we evaluated the use of HUTT in pediatric patients aged 3-5 years with orthostatic intolerance. Materials and Methods: The medical history and HUTT records of 345 (180 males, aged from 3 to 5 years) cases of patients who complained of symptoms of orthostatic intolerance and who visited the Syncope Ward, Children's Medical Center, The Second Xiangya Hospital, Central South University from January 2003 to December 2019, were reviewed retrospectively. Results: Seventy-nine (22.9%) cases had positive responses to complete HUTT (basic HUTT and sublingual nitroglycerin HUTT), while 29 (8.4%) cases had positive responses if only basic HUTT was performed. Sublingual nitroglycerin provocation significantly increased the positive rate of the test (x 2= 27.565, P < 0.001). The most frequent hemodynamic response to HUTT was vasoinhibitory type vasovagal syncope (12.2%), Syncope (28.7%), and dizziness (22.6%) were the most common symptoms. Eight cases discontinued the test due to intolerable symptoms without severe adverse events occurring. Conclusions: HUTT was safe and well-tolerated and could be used to diagnose the hemodynamic type of orthostatic intolerance in children aged 3-5 years.
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Affiliation(s)
- Runmei Zou
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shuo Wang
- Jishou University School of Medicine, Jishou, China
| | - Fang Li
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ping Lin
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Juan Zhang
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yuwen Wang
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yi Xu
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Cheng Wang
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
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Zou R, Wang S, Li F, Lin P, Zhang J, Wang Y, Xu Y, Wang C. Clinical characteristics and hemodynamic responses to head-up tilt test in children and adolescents with unexplained sighing. Neurol Sci 2021; 42:3343-3347. [PMID: 33411193 DOI: 10.1007/s10072-020-04956-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/01/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Sighing is a common symptom in children and adolescents. In this study, we explored the clinical characteristics and hemodynamic responses to head-up tilt test (HUTT) in children and adolescents with unexplained sighing. METHODS One hundred ninety-two children and adolescents complaining of unexplained sighing were enrolled as study group after excluding chest wall, lung, heart diseases, and psychogenic disorders. Sixty-nine healthy individuals were enrolled as control group. All the subjects underwent HUTT. RESULTS Nitroglycerin-stimulated HUTT positive rate was higher in the study group than the control group (24.0% vs 10.1%, P = 0.014). In total, 32.3% of patients with sighing had positive responses to HUTT, which was higher than that of healthy individuals (32.3% vs 15.9%, P = 0.009). Among 62 cases with positive responses to HUTT in the study group, 48 cases were vasoinhibitory type vasovagal syncope (VVS), 5 cases were mixed type VVS, 3 cases were cardioinhibitory type VVS, 5 cases were postural tachycardia syndrome, and one case was orthostatic hypertension. Sighing patients with positive responses to HUTT had female dominance (54.8% vs39.2%, P = 0.045), older mean age (9.6 ± 2.8 vs 8.1 ± 2.7 years old, P = 0.001), higher basic systolic blood pressure (104.8 ± 10.4 vs 101.1 ± 9.9 mmHg, P = 0.019), and higher diastolic blood pressure (66.0 ± 7.5 vs 62.9 ± 9.2 mmHg, P = 0.021) compared with those of negative responses. CONCLUSIONS : Nearly one-third of children and adolescents with unexplained sighing had positive responses to HUTT, demonstrating that sighing was related to dysfunction of the autonomic nervous system. Elder female patients with higher systolic and diastolic blood pressure were more likely to have positive responses to HUTT.
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Affiliation(s)
- Runmei Zou
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Shuo Wang
- Jishou University School of Medicine, Jishou, 416000, Hunan, China
| | - Fang Li
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Ping Lin
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Juan Zhang
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Yuwen Wang
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Yi Xu
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Cheng Wang
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
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