Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Orthostatic Hypotension Is Differentially Associated with the Cerebellar Versus the Parkinsonian Variant of Multiple System Atrophy: a Comparative Study


Orthostatic hypotension (OH) is a cardinal feature of autonomic failure in multiple system atrophy (MSA); however, there are few comparative data on OH in the motor subtypes of MSA. In the present retrospective study, postural blood pressure drop after 3 min of standing was determined in 16 patients with the cerebellar variant of MSA (MSA-C) and in 17 patients with the Parkinson variant (MSA-P). Twenty idiopathic Parkinson’s disease (IPD) patients matched for age, sex, disease duration and dopaminergic therapy served as control group. OH frequency and severity were more pronounced in MSA-C followed by MSA-P and IPD. Differences in brainstem pathology are likely to account for the tight association of MSA-C and OH. A simple standing test should be obligatory in the work-up of patients with sporadic late-onset ataxias.

This is a preview of subscription content, log in to check access.


  1. 1.

    Wenning GK, Ben Shlomo Y, Magalhaes M, Daniel SE, Quinn NP. Clinical features and natural history of multiple system atrophy. An analysis of 100 cases. Brain. 1994;117(Pt 4):835–45.

  2. 2.

    Wenning GK, Scherfler C, Granata R, Bosch S, Verny M, Chaudhuri KR, et al. Time course of symptomatic orthostatic hypotension and urinary incontinence in patients with postmortem confirmed parkinsonian syndromes: a clinicopathological study. J neurol neurosurg psychiatry. 1999;67(5):620–3.

  3. 3.

    Wenning GK, Tison F, Ben Shlomo Y, Daniel SE, Quinn NP. Multiple system atrophy: a review of 203 pathologically proven cases. Mov Disord. 1997;12(2):133–47.

  4. 4.

    Kirchhof K, Apostolidis AN, Mathias CJ, Fowler CJ. Erectile and urinary dysfunction may be the presenting features in patients with multiple system atrophy: a retrospective study. Int J Impot Res. 2003;15(4):293–8.

  5. 5.

    Oertel WH, Wachter T, Quinn NP, Ulm G, Brandstadter D. Reduced genital sensitivity in female patients with multiple system atrophy of parkinsonian type. Mov Disord. 2003;18(4):430–2.

  6. 6.

    Daniel S. The neuropathology and neurochemistry of multiple system atrophy. In: Mathias CJ, Bannister R, editors. Autonomic failure: a textbook of clinical disorders of the autonomic nervous system. Oxford: Oxford University Press; 1999. p. 321–8.

  7. 7.

    Sung JH, Mastri AR, Segal E. Pathology of Shy-Drager syndrome. J Neuropathol Exp Neurol. 1979;38(4):353–68.

  8. 8.

    Shy GM, Drager GA. A neurological syndrome associated with orthostatic hypotension: a clinical–pathologic study. Arch Neurol. 1960;2:511–27.

  9. 9.

    Benarroch EE, Schmeichel AM, Sandroni P, Low PA, Parisi JE. Differential involvement of hypothalamic vasopressin neurons in multiple system atrophy. Brain. 2006;129(Pt 10):2688–96.

  10. 10.

    Papp MI, Lantos PL. The distribution of oligodendroglial inclusions in multiple system atrophy and its relevance to clinical symptomatology. Brain. 1994;117(Pt 2):235–43.

  11. 11.

    Benarroch EE, Schmeichel AM, Parisi JE. Involvement of the ventrolateral medulla in parkinsonism with autonomic failure. Neurology. 2000;54(4):963–8.

  12. 12.

    Goldstein DS. Dysautonomia in Parkinson’s disease: neurocardiological abnormalities. Lancet neurol. 2003;2(11):669–76.

  13. 13.

    Braune S. The role of cardiac metaiodobenzylguanidine uptake in the differential diagnosis of parkinsonian syndromes. Clin Auton Res. 2001;11(6):351–5.

  14. 14.

    Courbon F, Brefel-Courbon C, Thalamas C, Alibelli MJ, Berry I, Montastruc JL, et al. Cardiac MIBG scintigraphy is a sensitive tool for detecting cardiac sympathetic denervation in Parkinson’s disease. Mov Disord. 2003;18(8):890–7.

  15. 15.

    Kollensperger M, Seppi K, Liener C, Boesch S, Heute D, Mair KJ, et al. Diffusion weighted imaging best discriminates PD from MSA-P: a comparison with tilt table testing and heart MIBG scintigraphy. Mov Disord. 2007;22:1771–6.

  16. 16.

    Raffel DM, Koeppe RA, Little R, Wang CN, Liu S, Junck L, et al. PET measurement of cardiac and nigrostriatal denervation in Parkinsonian syndromes. J Nucl Med. 2006;47(11):1769–77.

  17. 17.

    Gilman S, Low P, Quinn N, Albanese A, Ben-Shlomo Y, Fowler C, et al. Consensus statement on the diagnosis of multiple system atrophy. American Autonomic Society and American Academy of Neurology. Clin Auton Res. 1998;8(6):359–62.

  18. 18.

    Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases. J neurol neurosurg psychiatry. 1992;55(3):181–4.

  19. 19.

    The Consensus Committee of the American Autonomic Society and the American Academy of Neurology. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. Neurology. 1996;46(5):1470.

  20. 20.

    Smith GD, Mathias CJ. Differences in cardiovascular responses to supine exercise and to standing after exercise in two clinical subgroups of Shy-Drager syndrome (multiple system atrophy). J neurol neurosurg psychiatry. 1996;61(3):297–303.

  21. 21.

    Senard JM, Rai S, Lapeyre-Mestre M, Brefel C, Rascol O, Rascol A, et al. Prevalence of orthostatic hypotension in Parkinson’s disease. J neurol neurosurg psychiatry. 1997;63(5):584–9.

  22. 22.

    Thaisetthawatkul P, Boeve BF, Benarroch EE, Sandroni P, Ferman TJ, Petersen R, et al. Autonomic dysfunction in dementia with Lewy bodies. Neurology. 2004;62(10):1804–9.

  23. 23.

    Krygowska-Wajs A, Furgala A, Laskiewicz J, Szczudlik A, Thor PJ. Early diagnosis of orthostatic hypotension in idiopathic Parkinson’s disease. Folia medica Cracoviensia. 2002;43(1–2):59–67.

Download references


We thank the referring consultant neurologists at the National Hospital for Neurology and Neurosurgery, Queen Square, London.

Conflicts of Interest

Financial disclosure related to this manuscript: All authors have nothing to disclose.

Financial disclosure: Gregor K. Wenning has received research grants from the Austrian science fund (FWF), Innsbruck Medical University (MUI) and the Österreichische Nationalbank (OeNB). He also received honoraria for consultancies from AstraZeneca and TEVA. Klaus Seppi has received honoraria for speaking and consulting from Novartis, Boehringer Ingelheim, Lundbeck, Schwarz Pharma, UCB Pharma and GlaxoSmithKline. Florian Krismer was supported by a research grant from österreichische Nationalbank (OeNB). Werner Poewe has received consultancy and lecture fees from AstraZeneca, Teva, Novartis, GSK, Boehringer Ingelheim, UCB, Orion Pharma and Merck Serono in relation to clinical drug development programmes for PD. Roberta Granata, Susanne Dürr, Katharine Bleasdale-Barr and Christopher J. Mathias have nothing to disclose.

Author information

Correspondence to Gregor Karl Wenning.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Wenning, G.K., Granata, R., Krismer, F. et al. Orthostatic Hypotension Is Differentially Associated with the Cerebellar Versus the Parkinsonian Variant of Multiple System Atrophy: a Comparative Study. Cerebellum 11, 223–226 (2012).

Download citation


  • Orthostatic hypotension
  • Multiple system atrophy
  • Parkinson’s disease
  • Postural blood pressure test
  • Autonomic failure