Improvements in resting heart rate and symptoms of postural orthostatic tachycardia syndrome in a 26-year-old female under upper cervical chiropractic care and neurorehabilitation
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1
Private Practice, United States
Background
A 26-year-old female presented with chronic symptoms related to postural orthostatic tachycardia syndrome. Her chief complaint was a feeling of feinting and loss of vision upon standing or mild exertion. She also presented with a persistent feeling of dizziness, rapid resting heart rate, cognitive fog, small- fiber neuropathy, and fatigue.
Clinical Features and Intervention:
A comprehensive examination was performed that included an evaluation of the craniocervical junction per the NUCCA protocol, bedside oculomotor exam, and sensorimotor exam. The patient showed saccadic intrusions on gaze fixation, right sided convergence insufficiency, horizontal pursuits, and vertical pursuits. The patient would get dizzy during sinusoidal pursuits as well as dynamic visual acuity testing almost immediately after the movement began. Pulse in a seated positon was measured at 98 bpm while pulse on standing was measured at 117 bpm.
The patient was seen for 12 weeks. A vectored NUCCA upper cervical correction was performed alone on the first visit. Subsequent visits where the patient did not meet the criteria for a NUCCA adjustment, neurorehabilitation was performed utilizing a combination of canalith repositioning maneuver, seated and standing gaze stability, figure-8 complex extremity movements, and convergence bead-string exercises
Results:
The patient reported an immediate improvement in visual loss and feeling of feinting after the first NUCCA correction. On subsequent visits the patient self-reported improved energy, decreased feelings of dizziness, improved night time vision, improved ability to see vehicle head lights at night. The patient states that she was able to walk and track moving objects without feeling disoriented. The patient also reported that she was able to return to working on a part-time basis for the first time in 2 years. On re-examination the patient was able to perform pursuits and dynamic visual acuity testing without dizziness. The patient also showed a resting seated heart rate of 76 bpm and standing heart rate of 85 bpm at 12 weeks.
Conclusion:
Further research into the effects of upper cervical chiropractic in combination with multi-modal neurorehabilitation for postural orthostatic tachycardia syndrome are warranted.
References
1. Aoki M, Sakaida Y, Tanaka K, Mizuta K, Ito Y. Evidence for vestibular dysfunction in orthostatic hypotension. Exp Brain Res. 20112 Mar; 217(2):251-9.
2. Woodfield HC 3rd, Hasick DG, Becker WJ, Rose MS, Scott JN. Effect of atlas vertebrae realignment in subjects with migraine: an observational pilot study. Biomed Res Int. 2015; 2015: 63042.
3. Arata M, Sternberg Z. Transvascular autonomic modulation: a modified balloon angioplasty technique for the treatment of autonomic dysfunction in multiple sclerosis patients. J Endovasc Ther. 2014 Jun;21(2):417-28.
Keywords:
POTS,
dysautonomia,
Vestibular Rehabilitation,
Chiropractic,
Functional Neurology
Conference:
International Symposium on Clinical Neuroscience 2018, Orlando, Florida, United States, 24 May - 26 May, 2018.
Presentation Type:
Poster
Topic:
Clinical Applications in health, disease, and injury to the nervous system
Citation:
Chung
J
(2018). Improvements in resting heart rate and symptoms of postural orthostatic tachycardia syndrome in a 26-year-old female under upper cervical chiropractic care and neurorehabilitation.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience 2018.
doi: 10.3389/conf.fneur.2018.60.00051
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Received:
28 Mar 2018;
Published Online:
14 Dec 2018.
*
Correspondence:
Dr. Jonathan Chung, Private Practice, Royal Palm Beach, FL, 33414, United States, jonchungdc@gmail.com