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NEUROLOGY 1989;39:34
© 1989 American Academy of Neurology

Sympathotonic orthostatic hypotension

A report of four cases

Robert D. Hoeldtke, MD, PhD, Gerald E. Dworkin, DO, Stephen R. Gaspar, MD and Beth C. Israel, MS

Department of Medicine, Division of Endocrinology and Metabolism, the Department of Physical Medicine and Rehabilitation, and the General Clinical Research Center, Temple University School of Medicine, Philadelphia, PA.

We describe four patients with sympathotonic orthostatic hypotension, a syndrome in which the decrease in blood pressure associated with standing is accompanied by tachycardia. The patients in this series had experienced either a viral infection or rapid weight loss prior to the onset of their orthostatic intolerance. Vasomotor reflexes and norepinephrine production were normal, and analysis of palmar autonomic surface potentials indicated that the sympathetic innervation of the upper extremities was intact. The amplitudes of the plantar autonomic surface potentials, however, were decreased although still within the normal range. The latencies of plantar autonomic surface potentials were slightly prolonged. Although most autonomic function tests are normal in sympathotonic orthostatic hypotension, mild abnormalities in the plantar autonomic surface potentials may indicate a neuropathy that primarily affects low thoracic or lumbar sympathetic neurons.

Address correspondence and reprint requests to Dr. Hoeldtke, Department of Medicine, Temple University Health Sciences Center, 3401 North Broad Street, Philadelphia, PA 19140

Supported by USPHS grants AGO481, AM32239, and RR00394 to the General Clinical Research Center.

Received March 3, 1988. Accepted for publication in final form July 1, 1988.




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