Abstract Details

Title Postural Tachycardia Syndrome might be a Cause of Cerebrospinal Fluid Hypovolemia

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 7-053

Objective

The purpose of this study is to clarify the relationship between postural tachycardia syndrome and cerebrospinal fluid hypovolemia.

Background Headache attributed to low cerebrospinal fluid (CSF) pressure is classified into three parts; post-lumbar puncture headache, CSF fistula headache, and headache attributed to spontaneous intracranial in ICHD-3. When we encounter a patient with typical orthostatic headache but without apparent cause, we should exclude postural tachycardia syndrome (POTS). hypotension However the orthostatic headache due to POTS is not classified in ICHD-3. There is no hypothesis to explain why POTs caused orthostatic headache.

Design/Methods

We performed active standing test and RI cisternography by SPECT/CT in 9 patients complaining orthostatic headache. We measured blood pressure and pulse rate in the active standing test. We also checked leakage of CSF in patients with orthostatic headache using newly developed RI cisternography by SPECT/CT.

Results

Six of 9 patients were suffering from POTS and 3 of 9 were not. All of 3 were confirmed as having CSF leakage but CSF pressure was over 10 cmH₂O. Six cases suffering from POTS approved CSF hypovolemia (CSF pressure was less than 6.5 cmH₂O). CSF leakage was ruled out in 5 of them.

Conclusions

Our data suggest that POTS patients tend to have CSF hypovolemia. Animal studies suggested that the stimulation of sympathetic nerve reduced the production of CSF. It is well known POTS accompanies sympathetic hyperactivity, and sympathetic hyperactivity may suppress CSF production.

POTS might cause CSF hypovolemia via sympathetic hyperactivity, and might induce orthostatic headache.

Authors/Disclosures
Nobuo Araki, MD PRESENTER	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file

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