Publication: Pure Autonomic Failure: A Case Report of Recurrent Orthostatic Hypotension
Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
Nepal Medical Association
Abstract
Abstract:
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.
Description
Prabin Khatri
Department of Internal Medicine, Universal College of Medical Sciences, Bhairahawa, Nepal
Himal Panth
Universal College of Medical Sciences, Bhairahawa, Nepal
Sabina Khadka
Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal
Pramila Thapa
Lumbini Medical College, Palpa, Nepal
Rajshree Regmi
Lumbini Medical College, Palpa, Nepal
Sunil Shah
Universal College of Medical Sciences, Bhairahawa, Nepal
Sumit Gami
Universal College of Medical Sciences, Bhairahawa, Nepal
Ashutosh Upadhyaya
Universal College of Medical Sciences, Bhairahawa, Nepal
Mohammad Rizwan Alam
Universal College of Medical Sciences, Bhairahawa, Nepal
Srijana Sharma
Universal College of Medical Sciences, Bhairahawa, Nepal
Keywords
midodrine, orthostatic hypotension, pure autonomic failure