scholarly journals Neglected cause of recurrent syncope: a case report of neurogenic orthostatic hypotension

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Robert J H Miller ◽  
Derek S Chew ◽  
Satish R Raj
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
Orthostatic Hypotension ◽  
Correct Diagnosis ◽  
Valsalva Manoeuvre ◽  
System Failure ◽  
Neurogenic Orthostatic Hypotension ◽  
Physician Visits ◽  
Autonomic Nervous ◽  
History Of

Abstract Background Syncope commonly results in emergency room and physician visits, leading to hospitalization and invasive investigations. Up to 24% of these presentations may be caused by neurogenic orthostatic hypotension (nOH), which continues to be an under-recognized clinical entity. We review an approach to diagnosing nOH. Case summary An 85-year-old man with a history of Parkinson’s disease was referred for a history of recurrent syncope, which had resulted in extensive cardiac investigation. Collateral history revealed that the events were orthostatic in nature, but with variable time to onset of symptoms. The patient was found to have significant postural drop in blood pressure without compensatory tachycardia. Cardiovascular autonomic function testing was performed, which confirmed significant autonomic nervous system failure, including a marked hypotensive response on tilt-table testing and a lack of vasoconstriction during Valsalva manoeuvre. The patient was diagnosed with nOH and initiated on midodrine with subjective improvement in the frequency of syncope. Discussion Autonomic nervous system failure, with nOH, is a common cause of recurrent syncope, particularly in older patients. Attention to detail during the medical history, including precipitating factors and the presence of prodromal symptoms prior to syncope, is critical for making the correct diagnosis. Measuring orthostatic vital signs correctly in patients with syncope provides valuable information, is cost-effective, and critical to diagnose nOH.

Blood Pressure and Orthostatic Hypotension: Faints, Near-Faints, and Lightheadedness

2013 ◽  
Author(s):  
J. Eric Ahlskog
Keyword(s):  
Blood Pressure ◽  
Nervous System ◽  
Autonomic Nervous System ◽  
Orthostatic Hypotension ◽  
Vessel Diameter ◽  
Upright Position ◽  
Grocery Store ◽  
The Body ◽  
Autonomic Nervous ◽  
Neurodegenerative Process

Case example: Mrs. H. feels lightheaded intermittently during the day. This happens exclusively when she is up and about. Sometimes she notes graying of vision with these episodes. The feeling is not spinning (i.e., not vertigo). She has fainted twice when standing in line at the grocery store. If she sits, she feels much better. It is worse in the morning but may recur any time of the day. She feels fine while lying in bed at night. Older adults often worry about high blood pressure (BP), yet the opposite problem, low BP, is common among those with DLB or PDD. This is because the Lewy neurodegenerative process impairs the autonomic nervous system. The specific condition that may afflict those with DLB or PDD is orthostatic hypotension. The term orthostatic implies the upright position (i.e., standing); hypotension translates into low BP. Thus, the low BP occurring in these Lewy disorders develops in the upright position; conversely, it is normal or even high when lying down. When standing or walking, the BP may drop so low that fainting occurs. Among people with orthostatic hypotension, the BP is normal when sitting, although in severe cases, even the sitting BP is low. Whereas most people with DLB or PDD do not experience symptoms of orthostatic hypotension, it is sufficiently frequent to deserve attention. It often goes undiagnosed, even when fainting occurs. Unrecognized orthostatic hypotension may limit activities and impair the person’s quality of life. The first half of this chapter provides further background, with focus on BP measurement and recognition of orthostatic hypotension. The last half addresses treatment. The normal autonomic nervous system senses the position of our body with respect to the pull of gravity. It is able to reflexively counter gravity’s downward pull on the blood volume when standing (gravity tends to draw blood toward our feet when standing). An important mechanism for countering gravity’s pull is the constriction of blood vessel diameter in the lower half of the body. These vessels reflexively constrict during standing, in effect forcing blood up to the brain. The autonomic nervous system mediates these and other reflexive changes to stabilize BP.

scholarly journals Sensitivity of the Baroreceptors and the State of the Autonomic Nervous System in Patients with Chronic Impairment of Consciousness Due to Severe Brain Damage

2019 ◽  
Vol 15 (5) ◽  
pp. 61-73 ◽  
Author(s):  
V. N. Dorogovtsev ◽  
D. S. Yankevich ◽  
A. L. Parfenov ◽  
A. E. Skvortsov ◽  
A. V. Kotelnikova
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
Orthostatic Hypotension ◽  
Brain Damage ◽  
Main Trend ◽  
Control Group ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Orthostatic Test ◽  
Autonomic Nervous ◽  
Group 1

Purpose of the study: to examine sensibility of baroreceptors and the autonomic nervous in the passive orthostatic test in patients with chronic impairment of consciousness due to severe brain damage and determine their role in the rehabilitation process.Materials and methods. The study included 30 patients with long-term impairment of consciousness due to severe brain damage (group 1), 10 of them being in the vegetative state (VS) and 20 being in the minimally conscious state (MCS). Craniocerebral trauma was the main cause of severe damage in that group (53% of patients). The comparison group included 24 patients with focal neurological symptoms caused predominantly — 79.2% of cases — by cerebrovascular disorders (group 2). The control group (group 3) consisted of 22 healthy volunteers of a comparable age. All measurements were done with the help of a Task Force Monitor 1030i (CNSystem, Austria) in the course of passive orthostatic test at 0°–30°–60°–0°. Changes in the power of low-frequency (LFS) and highfrequency spectrum (HFS) of heart rate variability and baroreceptors sensibility (BRS) were analyzed. Statistical analysis was carried out using Statistica-10 software. Significance of inter-group differences on unrelated samples was determined by the Mann–Whitney U-test. Differences between groups were considered significant at P 0.05.Results. Maximal background values of BRS were found in the control group. In group 1 and 2 patients, considerable decrease of that index was noted, which was proportional to the brain damage severity. Similar dynamics was observed for the indices of autonomic nervous system sensibility (LFS and HFS). The main trend of orthostatic changes of BRS, LFS, and HFS was characterized by progressive decrease of the indices with increase of the patients’ angle of tilting and their return to the baseline level after the patients were put back into the horizontal position. 4 patients of group 1 (14%) displayed signs of orthostatic disorders upon tilting to 30°: in 3 cases, orthostatic hypotension was observed, and in one case the postural orthostatic tachycardia syndrome (POTS) was diagnosed. Those patients differed by lower BRS and higher sympathetic system activity (LFS) vs. the same indices of other patients in that group.Conclusion. Patients with chronic impairment of consciousness during the post-comatose period after a severe brain damage display a significant decrease of baroreceptors sensibility and autonomic nervous system disorders manifesting in significantly lower activity of the sympathetic and parasympathetic systems. The prominence of such disorders is associated with brain damage severity. Their risk of developing orthostatic hypotension during tilting towards a vertical position is higher in patients who have lower baroreceptors sensibility, and this should be taken into account beginning the process of their verticalization.

CHANGES IN ELECTROENCEPHALOGRAM INDICATORS IN ADOLESCENTS WITH VEGETATIVE DYSFUNCTION

2021 ◽  
Vol Special issue (3) ◽  
pp. 17-20
Author(s):  
Shadie Kurtieva ◽  
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
Clinical Manifestation ◽  
Autonomic Dysfunction ◽  
Recovery Period ◽  
Physical Exertion ◽  
Physical Parameters ◽  
Autonomic Nervous ◽  
Perinatal Pathology ◽  
History Of

This work is based on the results of a study of the assessment of physical parameters of the electroencephalogram in adolescents with autonomic dysfunction, depending on gender and the presence of perinatal pathology in the anamnesis. We examined 87 adolescents 12-18 years old with clinically and laboratory-instrumental confirmed dysfunction of the autonomic nervous system -autonomic dystonia syndrome (ADS). The average age of the clinical manifestation of ADS in girls was 12.2 ± 1.8 years, in boys -13.5 ± 2.1 years. As a result of the study, it was revealed that adolescents with a history of perinatal pathology have the maximum risk of disturbances in the processes of myocardial repolarization at the end of the recovery period after physical exertion, especially in females

Effect of Bortezomib on the Autonomic Nervous System.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5101-5101
Author(s):  
Roberto Crocchiolo ◽  
Stefania Ferrari ◽  
Valeria Calbi ◽  
Magda Marcatti ◽  
Elena Guggiari ◽  
...  
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
Orthostatic Hypotension ◽  
Postural Hypotension ◽  
Response To Therapy ◽  
Disease Stage ◽  
Drug Discontinuation ◽  
Disease Response ◽  
Autonomic Nervous ◽  
Sum Score

Abstract Background Peripheral neuropathy is one of the most frequent adverse events associated to bortezomib therapy; among neuropathic syndromes, postural hypotension is described as well. However, information on disautonomic toxicity are limited and there are no studies addressed to this particular issue so far. Before starting this study we had observed a case of dramatic acute autonomic failure during bortezomib treatment in a patient with advanced multiple myeloma, who developed severe orthostatic hypotension, tachycardia and impairment to tolerate the sitting and orthostatic posture for several weeks. Methods We prospectively studied 12 consecutive patients, treated with bortezomib at our Institution between February 2005 and July 2006. Assessment included neurological examination, INCAT Disability scale, INCAT sensory sum score, MRC sum score, nerve conduction studies, and standard cardiovascular autonomic tests including Lying to standing, Deep breathing and Postural hypotension. These tests were conducted baseline and after each bortezomib 21-days cycle up to three consecutive cycles. Results Two pts showed a clinically evident autonomic involvement with orthostatic hypotension; a change to a pathological score in 2 out of 3 tests anticipated clinical disautonomic signs in 1 and 11 weeks respectively. Clinical impairment showed to be reversible in both cases. Four pts presented only 1 pathological test (without any clinical sign or symptom of postural hypotension) and 6 patient had normal results. There was no apparent correlation between autonomic impairment and disease response to therapy or patients baseline characteristics (disease stage, Ig class, previous anti-myeloma therapies, concomitant thalidomide or anti-hypertensive treatment); furthermore, none had evidence of amyloidosis. Conclusions Our prospective study confirms that autonomic dysfunction is a potential adverse effect of bortezomib. Autonomic, non invasive, cardiovascular testing may reveal subclinical involvement and precede clinical evidence of disautonomic neuropathy. Further studies in larger cohorts of patients are needed to clarify the interactions between proteasome inhibitor activity and autonomic nervous system, in order to assess the frequency, the ability of available test in early pre-clinical diagnosis and the potential of the reversibility of neuropathic signs after drug discontinuation.

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