, Volume 113, Issue 3, pp 337-339
Date: 16 Nov 2012

Autonomic dysfunction in multiple sclerosis presenting with postural orthostatic tachycardia

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Introduction

Postural orthostatic tachycardia syndrome (POTS) is an autonomic disorder characterized by an exaggerated increase in heart rate that occurs during standing, without orthostatic hypotension.

We report a patient with postural orthostatic tachycardia in a context of multiple sclerosis (MS).

Case report

A 37-year-old woman presented with hemiparesthesia on the left side of the body. Neurological examination revealed left-sided hemihypoesthesia. Brain MRI revealed six T2 hyperintensive lesions, the largest one in the right thalamus with postcontrast enhancement. CSF analysis showed positive IgG oligoclonal bands (OCB), without OCB in the serum. Syncope occurred during the lumbar puncture so tilt-table test was performed. Immediately after the tilt, excessive heart rate rise >30 beats/min occurred, persisting during the whole tilt phase, with no change in the blood pressure values. In the 12th min of the tilt phase a loss of blood pressure occurred (minimal values 68.9/43.8 mmHg) w ...