Archiv für Psychiatrie und Nervenkrankheiten

, Volume 221, Issue 2, pp 139–155 | Cite as

Idiopathische orthostatische Hypotension (Shy-Drager-Syndrom)

Ergebnisse regionaler Hirndurchblutungsmessungen
  • A. Hartmann
  • E. Alberti
  • W. Dorndorf
  • M. Kresse
Article

Zusammenfassung

Bei einem Patienten mit idiopathischer orthostatischer Hypotension wurde mit Hilfe der Gamma-Kamera und der Xenon-133-Technik die regionale Hirndurchblutung gemessen. Der Blutdruck wurde durch Veränderung der Körperlage des Patienten beeinflußt. Es wurde ein partieller Defekt der Autoregulation und der Sensitivität auf Änderung des arteriellen Kohlendioxydgehaltes gefunden. Darüberhinaus war eine Überemp-findlichkeit des Blutdrucks auf Norepinephrin nachzuweisen. Klinische Symptomatik, Therapie und histopathologische Befunde werden diskutiert.

Schlüsselwörter

Idiopathische orthostatische Hypotension Cerebrale Durchblutung Neurogene Kontrolle Autoregulation 

Idiopathic orthostatic hypotension (Shy-Drager Syndrome)

Results of regional cerebral blood flow measurements

Summary

Using a gamma camera and the stochastic method, regional cerebral blood flow was measured in a patient with the diagnosis of idiopathic orthostatic hypotension. Blood pressure was altered by tilting the patient in supine position head-up and head-down. A partial defect in the autoregulation and CO2 sensitivity was found. Sensitivity to Norepinephrine was checked by intravenous infusion of 0. 02 μg/min/kg body weight. An immediate marked rise in blood pressure was observed. Clinical symptoms, therapeutic guidelines, and histopathological findings are discussed.

Key words

Idiopathic Orthostatic Hypotension Cerebral Blood Flow Neurogenic Control Autoregulation 

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Literatur

  1. 1.
    Bannister, R., Ardill, L., Fentem, P.: Defective autonomic control of blood vessels in idiopathic hypotension. Brain 90, 725–746 (1967)Google Scholar
  2. 2.
    Bethune, H. C., Burrell, R. H., Culpan, R. H., Ogg, G. J.: Vascular crises associated with monoamine oxidase inhibitors. Amer. J. Psychiat. 121, 245–248 (1964)Google Scholar
  3. 3.
    Boticelli, J. T., Keelan, M. H., Rosenbaum, F. F., Lange, R. L.: Circulatory control in idiopathic orthostatic hypotension. Circulation 38, 870–879 (1968)Google Scholar
  4. 4.
    Bradbury, S., Eggleston, C.: Postural hypotension. A report of three cases. Am. Heart J. 1, 73–86 (1926)Google Scholar
  5. 5.
    Caronna, J. J., Plum, F.: Cerebrovascular regulation in preganglionic and postganglionic autonomic insufficiency. Stroke 4, 12–19 (1973)Google Scholar
  6. 6.
    Chokroverty, S., Barron, K. D., Katz, F. H., Del Greco, F., Sharp, J. T.: The syndrome of primary orthostatic hypotension. Brain 92, 743–768 (1969)Google Scholar
  7. 7.
    Detre, T. P., Jarecki, H. C.: Modern Psychiatric Treatment. J. P. Lippincott Co., Philadelphia (1970)Google Scholar
  8. 8.
    Falck, B., Nielsen, K. C., Owman, C.: Adrenergic innervation of the pial circulation. Scand. J. Clin. Lab. Invest. 22 (Suppl. 102) 6 B (1968)Google Scholar
  9. 9.
    Ghrist, D. G.: Postural hypotension. Proc. Staff Meet. Mayo Clinic 2, 117 (1927)Google Scholar
  10. 10.
    Goetz, R. H.: The surgical physiology of the sympathic nervous system with special reference to cardiovascular disorders. Internat. Abstr. Surg. 87, 417 (1948)Google Scholar
  11. 11.
    Goldberg, H., Elisberg, E. I., Katz, L. N.: The effect of the Valsalva-like maneuver upon the circulation in normal individuals and patients with mitral stenosis. Circulation 5, 38–47 (1952)Google Scholar
  12. 12.
    Gotoh, F., Ebihara, S., Toyoda, M., Shinohara, Y.: Role of autonomic nervous system in autoregulation of human cerebral circulation. Panminerva Med. 13, 175 (1971)Google Scholar
  13. 13.
    Grimson, K. S.: Surgical treatment of hypertension. Collective review. Surg., Gynec., and Obst. 75, 421–442 (1942)Google Scholar
  14. 14.
    Gurtner, B., Lüthy, F.: Orthostatische Hypotonie als Teilsymptom eines primär-neurologischen Leidens. Schweiz. med. Wschr. 94, 296–300 (1964)Google Scholar
  15. 15.
    Harmel, M. H., Hafkenschiel, J. H., Austin, G. M.: The effect of bilateral stellate ganglion block on the cerebral circulation in normotensive and hypertensive patients. J. Clin. Invest. 28, 415–418 (1949)Google Scholar
  16. 16.
    Hartmann, A., Alberti, E., Lange, D., Mathew, N. T.: CBF-measurement from three sides: in patients with intracerebral tumors. Advances in Neurosurgery (in print) (1975)Google Scholar
  17. 17.
    Hickler, R. B., Thompson, G. R., Fox, L. M., Hamlin, J. T.: III. Successful treatment of orthostatic hypotension with 9-alpha-Fluorohydrocortisone. New Eng. J. Med. 261, 788–791 (1959)Google Scholar
  18. 18.
    Hohl, R. D., Frand, B., Schatz, J.: The Shy-Drager variant of idiopathic orthostatic hypotension. Am. J. Med. 39, 134–141 (1965)Google Scholar
  19. 19.
    Hughes, R. C., Cartlidge, N. E. F., Millac, P.: Primary neurogenic orthostatic hypotension. J. Neurol. Neurosurg. Psychiat. 33, 363–371 (1970)Google Scholar
  20. 20.
    Iwayama, T., Furness, J. B., Burnstock, G.: Dual adrenergic and cholinergic innervation of the cerebral arteries of the rat. An ultrastructural study. Circ. Res. 26, 635–646 (1970)Google Scholar
  21. 21.
    James, J. M., Millar, R. A., Purves, M. J.: Observation on the extrinsic neural control of cerebral blood flow in the baboon. Circulation. Res. 25, 77–93 (1969)Google Scholar
  22. 22.
    Johnson, R. H., McLellan, D. L., Love, D. R.: Orthostatic hypotension and the Holmes-Adie syndrome. J. Neurol. Neurosurg. Psychiat. 34, 562–570 (1971)Google Scholar
  23. 23.
    Langfitt, T. W., Kassell, N. P.: Cerebral vasodilation produced by brainstem stimulation. Neurogenic control vs. autoregulation. Am. J. Physiol. 215, 90 (1968)Google Scholar
  24. 24.
    Levis, P.: Familial orthostatic hypotension. Brain 87, 719–728 (1964)Google Scholar
  25. 25.
    Meyer, J. S., Teraura, T., Sakamoto, K., Kondo, D.: Central neurogenic control of cerebral blood flow. Neurology (Minneap.) 21, 247–262 (1971)Google Scholar
  26. 26.
    Meyer, J. St., Shimazu, K., Fukuuchi, Y., Ohuchi, T., Okamoto, Sh., Koto, A., Ericsson, A. D.: Cerebral dysautoregulation in central neurogenic orthostatic hypotension (Shy-Drager-syndrome). Neurology (Minneap.) 23, 262–273 (1973)Google Scholar
  27. 27.
    Nelson, E., Rennels, M.: Neuromuscular contacts in intracranial arteries of the cat. Science 167, 301 (1970)Google Scholar
  28. 28.
    Nelson, E., Rennels, M.: Innervation of intracranial arteries. Brain 93, 475–490 (1970)Google Scholar
  29. 29.
    Nielsen, K. C., Owman, C.: Adrenergic innervation of pial arteries related to the circle of Willis in the cat. Brain Res. 6, 773–776 (1967)Google Scholar
  30. 30.
    Nielsen, K. C., Owman, C., Sporrong, B.: Ultrastructure of the autonomic innervation apparatus in the main pial arteries of rats and cats. Brain Res. 27, 25 (1971)Google Scholar
  31. 31.
    Odel, H. M., Roth, G. M., Keating, F. R. jr.: Autonomic neuropathy simulating the effects of sympathectomy as a complication of diabetes mellitus. Diabetes 4, 92–98, 19(1955)Google Scholar
  32. 32.
    Reivich, M.: Arterial pCO2 and cerebral hemodynamics. Am. J. Physiol. 206, 25–31 (1964)Google Scholar
  33. 33.
    Sato, S.: An electron microscopic study on the innervation of the intracranial artery of the rat. Am. J. Anat. 118, 873 (1966)Google Scholar
  34. 34.
    Scheinberg, P.: Cerebral blood flow in vascular disease of the brain. Amer. J. Med. 8, 139–147 (1950)Google Scholar
  35. 35.
    Schirger, A., Hines, E. A. jr., Molnar, G. D., Thomas, J. E.: Idiopathic orthostatic hypotension. J. Amer. med. Ass. 181, 822–826 (1962)Google Scholar
  36. 36.
    Schwarz, G.: The orthostatic syndrome of Shy-Drager. Arch. Neurol. 16, 123–139 (1967)Google Scholar
  37. 37.
    Shy, G. M., Drager, G. D.: A neurological syndrome associated with orthostatic hypotension. Arch. Neurol. 2, 511–527 (1960)Google Scholar
  38. 38.
    Skinhøj, E., Olesen, J., Strangaard, S.: Autoregulation and the sympathetic nervous system. A study in a patient with idiopathic orthostatic hypotension. In: Ross Russell R. W. (ed.) Brain and Blood Flow. Proceedings of the Fourth International Symposion on the Regulation of Cerebral Blood Flow, London, 1970. Pitman Ltd., London, 351–353 (1971)Google Scholar
  39. 39.
    Spingarn, C. L., Hitzig, M. W.: Orthostatic circulatory insufficiency: its occurrence in tabes dorsalis and Addison' s didease. Arch. Int. Med. 69, 23 (1942)Google Scholar
  40. 39a.
    Stone, H. L., Raichle, M. E., Hernadez, M.: The effect of sympathetic denervation on cerebral CO sensitivity. Stroke 5, 13–18 (1974)Google Scholar
  41. 40.
    Thomas, J. E., Schirger, A.: Neurologic manifestations in idiopathic orthostatic hypotension. Arch. Neurol. 8, 204–208 (1963)Google Scholar
  42. 41.
    Thomas, J. E., Schirger, A.: Orthostatic hypotension. Med. Clin. North Amer. 52, 809 (1968)Google Scholar
  43. 42.
    Ule, G.: Über die zentralen Kleinhirnkerne als möglichen Ursprungsort der Kletterfasern. Z. f. Zellforschung 46, 286–316 (1957)Google Scholar
  44. 43.
    Vanderhaeghen, J. -J., Périer, O., Sternon, J. E.: Pathological findings in idiopathic orthostatic hypotension. Arch. Neurol. 22, 207–214 (1970)Google Scholar
  45. 44.
    Wagner, H. N. jr.: Orthostatic hypotension. Bull. J. Hopkins Hosp. 105, 322 (1959)Google Scholar
  46. 45.
    Wagner, H. N. jr., Braunwald, E.: The pressor effect of the antidiuretic principle of the posterior pituitary in orthostatic hypotension. J. Clin. Invest. 35, 1412 (1956)Google Scholar
  47. 46.
    Waltz, A. G., Takenori, Y., Regli, F.: Regulatory responses of cerebral vasculature after sympathetic denervation. Amer. J. Physiol. 221, 298–302 (1971)Google Scholar
  48. 47.
    Weiss, S., Baker, J. P.: The carotid sinus reflex in health and disease. Its role in the causation of fainting and convulsions. Medicine 12, 298 (1933)Google Scholar

Copyright information

© Springer-Verlag 1975

Authors and Affiliations

  • A. Hartmann
    • 1
  • E. Alberti
    • 1
  • W. Dorndorf
    • 1
  • M. Kresse
    • 1
  1. 1.Neurologische UniversitätsklinikHeidelbergBundesrepublik Deutschland

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