Changes in Cerebral Blood Oxygenation Induced by Active Standing Test in Children with POTS and NMS

  • Ayumi Endo
  • Yukihiko Fujita
  • Tatsuo Fuchigami
  • Shori Takahashi
  • Hideo Mugishima
  • Kaoru Skatani
Conference paper
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 812)


Orthostatic dysregulation (OD) has been classified into subtypes by heart rate and blood pressure; however, the hemodynamics of brains have not yet been revealed. Therefore, we investigated changes in cerebral blood flow and oxygenation during an active standing test to clarify the pathophysiology of two subtypes: postural tachycardia syndrome (POTS) and neurally mediated syncope (NMS). We studied 31 children (15 boys, 16 girls; mean age, 14.0 ± 1.7 years) who presented with OD at the Department of Pediatrics and Child Health, Nihon University School of Medicine between 2009 and 2011. OD was diagnosed using the Japanese clinical guidelines for juvenile orthostatic dysregulation. After a 10-min resting period in the supine position, patients were asked to quickly stand up and keep upright for 10 min. Cerebral blood flow and cerebral oxygenation were measured using transcranial Doppler sonography and near-infrared spectroscopy. POTS showed a significant decrease of oxy-Hb and resistance index (RI), suggesting transient ischemia with maintainable cerebral autoregulation. NMS showed a decrease of oxy-Hb and an increase of RI, suggesting ischemia and impairment of autoregulation.


Orthostaticdysregulation Postural tachycardia syndrome Neurally mediated syncope Transcranial Doppler sonography Near-infrared spectroscopy 



This research was partly supported by a Grant-in-Aid from the Ministry of Education, Culture, Sports, Sciences and Technology of Japan (B23300247), and grants by Alpha Electron Co., Ltd. (Fukushima, Japan) and Iing Co., Ltd. (Tokyo, Japan).


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Copyright information

© Springer Science+Business Media, LLC 2014

Authors and Affiliations

  • Ayumi Endo
    • 1
  • Yukihiko Fujita
    • 1
  • Tatsuo Fuchigami
    • 1
  • Shori Takahashi
    • 1
  • Hideo Mugishima
    • 1
  • Kaoru Skatani
    • 2
    • 3
  1. 1.Department of Pediatrics and Child HealthNihon University School of MedicineItabashi-ku, TokyoJapan
  2. 2.Department of Neurological SurgeryNihon University School of MedicineTokyoJapan
  3. 3.Nihon University College of EngineeringTokyoJapan

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