scholarly journals Pure Autonomic Failure: A Case Report of Recurrent Orthostatic Hypotension

2021 ◽  
Vol 59 (238) ◽  
Author(s):  
Prabin Khatri ◽  
Himal Panth ◽  
Sabina Khadka ◽  
Pramila Thapa ◽  
Rajshree Regmi ◽  
...  
Keyword(s):  
Orthostatic Hypotension ◽  
Neurodegenerative Disorder ◽  
Autonomic Failure ◽  
Pure Autonomic Failure ◽  
Loss Of Consciousness ◽  
Sitting Position ◽  
Pharmacological Interventions ◽  
Autonomic Dysfunctions ◽  
Effective Role ◽  
Multiple Episodes

Pure autonomic failure is a neurodegenerative disorder affecting the autonomic nervous system which clinically presents with orthostatic hypotension. It is a diagnosis of exclusion after detailed clinical examinations and relevant investigations. Here, we discuss a case of 68 years old male who had complaints of multiple episodes of loss of consciousness on standing from a sitting position for the last 3 years. The diagnosis was considered by clinical examinations revealing autonomic dysfunctions with normal appropriate investigations. The patient was treated successfully with midodrine, fludrocortisone, and other non-pharmacological interventions. We focused on doing various autonomic dysfunction tests in the evaluation of a patient with recurrent orthostatic hypotension. We suspect that pure autonomic failure might not have been considered in the differential diagnosis of recurrent orthostatic hypotension and suggest that it is to be kept as a differential in such a scenario. Midodrine has an effective role in syncope due to sympathetic vasoconstrictor failure.

Cognitive functioning in orthostatic hypotension due to pure autonomic failure

2006 ◽  
Vol 16 (2) ◽  
pp. 113-120 ◽  
Author(s):  
Hannah C Heims ◽  
Hugo D. Critchley ◽  
Naomi H. Martin ◽  
H. Rolf Jäger ◽  
Christopher J. Mathias ◽  
...  
Keyword(s):  
Orthostatic Hypotension ◽  
Cognitive Functioning ◽  
Autonomic Failure ◽  
Pure Autonomic Failure

Abstract P379: Patient and Caregiver Experiences With the Diagnosis of Neurogenic Orthostatic Hypotension

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Lawrence A Hewitt ◽  
Charles H Adler ◽  
Daniel O Claassen ◽  
Christopher H Gibbons ◽  
Satish R Raj
Keyword(s):  
Orthostatic Hypotension ◽  
Autonomic Failure ◽  
Pure Autonomic Failure ◽  
Accurate Diagnosis ◽  
First Year ◽  
Neurogenic Orthostatic Hypotension ◽  
Postural Change ◽  
Sustained Reduction ◽  
Caregiver Experiences

Objective: To understand the challenges to diagnosis in patients with neurogenic orthostatic hypotension (nOH) Background: nOH is a sustained reduction in blood pressure (BP) with postural change associated with autonomic dysfunction. Despite symptoms of nOH, many patients struggle to find an accurate diagnosis. Methods: An online, US-based survey designed by the authors was conducted by Harris Poll. Eligible participants were ≥18 years of age with Parkinson disease, multiple system atrophy, or pure autonomic failure and ≥1 of the following: orthostatic hypotension (OH), nOH, low BP, OH/nOH symptoms, or were caregivers of eligible participants. Results: The survey included 363 patients and 128 caregivers. Groups were separate, where caregivers were not the caregivers to patient responders. Respondents indicated that patients experienced nOH symptoms long term (Table 1) . Most patients (69%) and caregivers (59%) reported discussing nOH symptoms with a healthcare provider (HCP) within the first year of symptom onset, but only 36% of patients and 16% of caregivers reported a formal diagnosis of OH or nOH. Of those with a formal diagnosis, the majority of patients (50%) were frustrated by the path to diagnosis and more than 40% of patients and caregivers reported that the patient saw ≥3 HCPs before diagnosis. After diagnosis, most patients (70%) and caregivers (60%) reported improved symptom management. Conclusions: This survey reveals that patients and caregivers may find the path to nOH diagnosis challenging and suggests increased awareness among HCPs is needed. Once a diagnosis is made nOH symptoms are better managed.

Abstract P381: Understanding the Symptoms of Neurogenic Orthostatic Hypotension: Results From a Survey of Patients and Caregivers

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Lawrence A Hewitt ◽  
Charles H Adler ◽  
Daniel O Claassen ◽  
Christopher H Gibbons ◽  
Satish R Raj
Keyword(s):  
Multiple System Atrophy ◽  
Parkinson Disease ◽  
Orthostatic Hypotension ◽  
Autonomic Failure ◽  
Alpha Synuclein ◽  
Pure Autonomic Failure ◽  
Motor Symptoms ◽  
Neurogenic Orthostatic Hypotension ◽  
The Past ◽  
Increased Risk

Objective: To understand the burden and impact of symptoms of neurogenic orthostatic hypotension (nOH) on patients Background: nOH and its symptoms such as dizziness/lightheadedness are common in patients with Parkinson disease (PD) and other forms of autonomic dysfunction. Methods: An author-designed, US-based survey was conducted by Harris Poll. Eligible participants were aged ≥18 years with PD, multiple system atrophy (MSA), or pure autonomic failure and ≥1 of the following: orthostatic hypotension, nOH, low BP, OH/nOH symptoms, or were caregivers of eligible patients. Results: Most patients (90%) had a diagnosis of PD, and most caregivers (88%) cared for a patient with PD (Table 1) . Patients (34%) and caregivers (49%) reported experiencing nOH symptoms before PD or MSA motor symptoms and >40% indicated that nOH symptoms were more troublesome than motor manifestations of PD or MSA. Less than a quarter (22%) of respondents suggested symptoms were most severe in the morning; more (30%) reported a consistent severity throughout the day. Patients (40%) and caregivers (63%) reported trouble managing symptoms during the day. In the past 12 months, a fall due to nOH symptoms was reported by 57% of patients and 80% of caregivers. Conclusions: These findings suggest that nOH symptoms may predate the onset of motor symptoms in neurodegenerative conditions linked to alpha-synuclein pathology. Many respondents report nOH symptoms are the same severity through the day. Patients with nOH may have trouble managing symptoms and note an increased risk for falls.

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