A Neurological Syndrome Associated with Orthostatic Hypotension

Introduction Perhaps, with the exception of adrenal insufficiency,1,2postural hypotension is coincident with involvement of the nervous system.3,4Many such cases are secondary to disorders like diabetes, syphilis, and other systemic diseases, which also affect the central or peripheral nervous system.4-12On exclusion of such disorders, however, one is left with an idiopathic orthostatic hypotension, which is almost invariably accompanied by clinical manifestation of nervous system involvement. Such patients may show wide swings in blood pressure, depending on body position, but do not have the pulse changes or symptoms, such as yawning, nausea, or increased sweating, associated with other types of syncope in which the nervous system is intact. The lesions of the nervous system present in a variety of ways, the commonest symptoms being loss of sweating, impotence, and, frequently, loss of sphincter control. Controversy exists as to whether the pathology of the nervous system is