Cerebellar impairment during an orthostatic challenge in patients with neurogenic orthostatic hypotension

Publication date: Available online 6 September 2018

Source: Clinical Neurophysiology

Author(s): Jacquie Baker, Justin R. Paturel, Kurt Kimpinski

Abstract

Objective

Compare activation patterns within the cortical autonomic network in patients with neurogenic orthostatic hypotension (NOH) versus healthy age-matched controls during an orthostatic challenge.

Methods

Fifteen health controls and 15 NOH patients performed 3 Valsalva maneuvers, and 5-minutes of lower-body negative pressure (LBNP) during a functional brain MRI.

Results

Compared to controls, NOH patients had significantly less activation within the cerebellum during both LBNP and VM. Both groups had significant activation of the bilateral insula and left thalamus during LBNP. No significant differences were found during the recovery phase of LBNP.

Conclusions

The cerebellum, which plays an important role in vestibulo-sympathetic reflexes, important for blood pressure adjustments during postural changes, appear to be affected in patients with NOH. The cerebellum also appears to be affected during other baroreflex mediated stressors such as the VM.

Significance

Orthostatic reflexes mediated by the cerebellum may be impaired in patients with NOH. The results suggest an additional pathological pathway in patients with autonomic failure.

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