Journal of Neurology

, Volume 246, Issue 10, pp 893–898

Symptoms associated with orthostatic hypotension in pure autonomic failure and multiple system atrophy

  • C. J. Mathias
  • Rajeev Mallipeddi
  • Katharine Bleasdale-Barr
Original communication

DOI: 10.1007/s004150050479

Cite this article as:
Mathias, C., Mallipeddi, R. & Bleasdale-Barr, K. J Neurol (1999) 246: 893. doi:10.1007/s004150050479

Abstract

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.

Key words OrthostatichypotensionAutonomic disordersSyncopePure autonomic failureMultiple system atrophy

Copyright information

© Steinkopff Verlag 1999

Authors and Affiliations

  • C. J. Mathias
    • 1
  • Rajeev Mallipeddi
    • 1
  • Katharine Bleasdale-Barr
    • 1
  1. 1.Neurovascular Medicine Unit, Division of Neurosience and Psychological Medicine, Imperial College School of Medicine at St Mary’s Hospital, Praed Street, London W2 INY, and Autonomic Unit, Department of Clinical Neurology, National Hospital for Neurology and Neurosurgery, Queen Square and Institute of Neurology, University College London, UK e-mail: c.mathias@ic.ac.uk, Tel.: +44-171-8861468, Fax: +44-171-8861540GB