Abstract
A 59-year old woman who presented with postural dizziness 50 years after an acute episode of poliomyelitis is described. There were no new neurological signs and no evidence of motor neuron disease. She had postural hypotension with an abnormal Valsalva. Investigations led to a diagnosis of hypo-adrenergic orthostatic hypotension, with a predominantly preganglionic sympathetic lesion and intact vagal baroreflex pathways. Although pure autonomic failure and multiple system atrophy are possible causes of circulatory autonomic failure, no other new neurological or autonomic features have developed during a 2 year follow-up. We propose that hypoadrenergic orthostatic hypotension may be a late complication of poliomyelitis. Deterioration in ambulatory ability in a patient with previous poliomyelitis should additionally include assessment of cardiovascular autonomic function.
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References
Munsat TL. Poliomyelitis—new problems with an old disease (Editorial).New Engl J Med 1991;324: 1206–1207.
Anderson AD, Levine SA, Gellert H. Loss of ambulatory ability in patients with old anterior poliomyelitis.Lancet 1972;ii: 1061–1063.
Dalakas MC, Madden DL, Papadopoulos NM, Shekarchi IC, Albrecht P, Krezlewicz A. Late postpoliomyelitis muscular atrophy: clinical, virologic and immunologic studies.Rev Inf Dis 1984;6 (suppl 2): S562-S567.
Wieling W, Borst C, Van Dongen Torman MA, Van der Hofstede JW, Van Brederode JFM, Dunning AJ. Relationship between impaired parasympathetic and sympathetic cardiovascular control in diabetes mellitus.Diabetologia 1983;24: 422–427.
Bannister R, Mathias C. Testing autonomic reflexes. In: Bannister R, ed.Autonomic Failure. A textbook of clinical disorders of the autonomic nervous system. Oxford: Oxford University Press, 1988; 289–307.
Collins VJ, Foster WL, West WJ. Vasomotor disturbances in poliomyelitis, with special reference to treatment with paravertebral sympathetic block.N Engl J Med 1947;236: 694–697.
Smith E, Rosenblatt P, Limauro AB. The role of the sympathetic nervous system in acute poliomyelitis.J Ped 1949;34: 1–11.
Low PA, Fealey RD. Structure and function of pre- and postganglionic neurons in pure autonomic failure and multiple system atrophy with autonomic failure. In: Bannister R, ed.Autonomic Failure. A textbook of clinical disorders of the autonomic nervous system. Oxford: Oxford University Press, 1988; 544–557.
Borg K, Sachs C, Kaijser L. Autonomic cardiovascular responses in antecedent poliomyelitis.Acta Neurol Scand 1988;77: 402–408.
Wieling W, ten Harkel ADJ, van Lieshout JJ. Spectrum of orthostatic disorders: classification based on an analysis of the short-term circulatory response upon standing.Clin Sci 1991;81: 241–248.
Imholz BPM, Wieling W, Langewouters GJ, van Montfrans GA. Continuous finger arterial pressure: utility in the cardiovascular laboratory.Clin Autonomic Res 1991;1: 43–53.
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ten Harkel, A.D.J., van Lieshout, J.J. & Wieling, W. Circulatory autonomic failure 50 years after acute poliomyelitis. Clinical Autonomic Research 1, 215–217 (1991). https://doi.org/10.1007/BF01824989
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DOI: https://doi.org/10.1007/BF01824989