Cerebral circulation, neurological and neuropsychological disorders in idiopathic arterial hypotension

Abstract

Objective: to evaluate the cerebral circulation in idiopathic arterial hypotension (IAH) in relation to neurological and neuropsychological disorders. Patients and methods. Sixty-five patients (mean age 40.2 [8, 14] years) with prolonged IAH were examined. Neuropsychological examination was made using the procedure adapted by A.R. Luria; different psychic functions (memory, speech, gnosis, praxis, thinking, attention, counting, writing, and reading) were studied. Cerebral hemodynamics was investigated using duplex scanning of the brachiocephalic arteries (BCA), middle cerebral arteries (MCA), internal jugular (IJV) and vertebral veins (VV). The patients were assigned to 2 groups: 1) 19 (29%) patients with somatoform disorders, 2) 46 (71%) patients with signs of the initial manifestations of chronic cerebrovascular insufficiency. Group 2 patients were older and had a longer history of IAH. Results. In all the patients, cerebral blood supply in the carotid system showed moderately lower arterial blood inflow with a compensatory vascular resistance decrease and balanced venous outflow reduction with increased vascular resistance. Group 2 patients had a substantial (to the lower normal range) blood flow decline in the vertebral artery along with increased peripheral resistance in the VV. The degree of neuropsychological derangement was inversely proportional to blood flow velocity in BCA and MCA and to blood outflow in IJV and VV.