Document Detail

Symptoms associated with orthostatic hypotension in pure autonomic failure and multiple system atrophy.
MedLine Citation:
PMID:  10552235     Owner:  NLM     Status:  MEDLINE    
The symptoms caused by or relating to orthostatic hypotension (over 20 mmHg systolic blood pressure) were evaluated using a questionnaire in 72 patients with primary chronic autonomic failure, 32 of whom had pure autonomic failure (PAF, and 40 multiple system atrophy (MSA). The most common posturally related symptoms were dizziness (84% PAF, 83% MSA), syncope (91% PAF, 45% MSA), visual disturbances (75% PAF, 53% MSA) and suboccipital/paracervical 'coat-hanger' neck pain (8 l% PAF, 53% MSA). Chest pain occurred mainly in patients with PAF (44% PAF, 13% MSA). Improvement occurred with sitting or lying flat. Non-specific symptoms (weakness, lethargy and fatigue) were common in both groups (91% PAF, 85% MSA); six patients (one PAF, five MSA) had these symptoms only. Postural symptoms (mainly dizziness and neck pain) were worse in the morning and with warm temperature, straining, exertion, arm movements and food ingestion; they were more common in PAF. Compensatory autonomic symptoms, such as palpitations and sweating, did not occur in either group. In conclusion, orthostatic hypotension caused symptoms of cerebral hypoperfusion (syncope, dizziness and visual disturbances); neck pain, presumably due to muscle hypoperfusion, also occurred frequently. These symptoms were exacerbated by various factors in daily life and were relieved by returning to the horizontal. Non-specific symptoms (such as fatigue) also were common. In MSA, despite substantial orthostatic hypotension, fewer patients had syncope, visual disturbance and neck pain; the reasons for this are unclear. Lack of these features does not exclude the need to assess and investigate orthostatic hypotension and possible autonomic failure.
C J Mathias; R Mallipeddi; K Bleasdale-Barr
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of neurology     Volume:  246     ISSN:  0340-5354     ISO Abbreviation:  J. Neurol.     Publication Date:  1999 Oct 
Date Detail:
Created Date:  1999-12-07     Completed Date:  1999-12-07     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0423161     Medline TA:  J Neurol     Country:  GERMANY    
Other Details:
Languages:  eng     Pagination:  893-8     Citation Subset:  IM; S    
Neurovascular Medicine Unit, Division of Neurosience and Psychological Medicine, Imperial College School of Medicine at St Mary's Hospital, Praed Street, London W2 INY, UK.
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MeSH Terms
Adaptation, Physiological
Aged, 80 and over
Autonomic Nervous System / physiopathology
Autonomic Nervous System Diseases / complications*
Brain Ischemia / etiology
Hypotension, Orthostatic / complications,  etiology*,  physiopathology*
Middle Aged
Multiple System Atrophy / complications*

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