Regional cerebral blood flow responses to rapid reductions in blood pressure after high level spinal cord injury: the effect of alpha1‐agonist (1068.8)

Abstract

Spinal cord injury (SCI) above the T6 level frequently results in orthostatic intolerance, but how cerebral blood flow (CBF) responds to an orthostatic challenge in SCI is poorly understood. It is also unclear how alpha1 agonists, meant to improve orthostatic tolerance, influence the CBF response. This study examined: 1) the acute regional CBF velocity (CBFv) response to acute blood pressure (BP) reductions secondary to orthostatic stress in SCI, compared to able‐bodied controls (AB), and 2) the effect of Midodrine (alpha1‐agonist) on orthostatic tolerance and CBFv regulation in SCI. Ten individuals with SCI >T6, and 10 age‐and sex‐matched controls had beat‐by‐beat BP, as well as middle and posterior cerebral artery blood velocity (MCAv, PCAv) recorded during a progressive tilt‐test to quantify the acute CBF response and orthostatic tolerance. Dynamic CBFv‐BP relationships were evaluated from the first 60s after tilt. The SCI group was tested again after administration of an alpha1‐agonist (10 mg midodrine) in order to elevate BP. The acute (i.e., 0‐30s after tilt) MCAv and PCAv responses were similar in SCI and AB. In contrast, Midodrine led to improved PCAv responses 30‐60 s (10±3 vs. 4±2 %decline; p<0.05) after tilt, and a 59% improvement in orthostatic tolerance (p<0.01). The vertebrobasilar region may be particularly susceptible to hypoperfusion in SCI, leading to increased orthostatic intolerance.Grant Funding Source: Supported by HSFC, NSERC, MSFHR & CNF