Which symptoms are associated with orthostatic hypotension in multiple system atrophy (MSA)?

Updated: Oct 17, 2018
  • Author: André Diedrich, MD, PhD; Chief Editor: Selim R Benbadis, MD  more...
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Symptoms associated with orthostatic hypotension include the following:

  • Light-headedness

  • Dizziness

  • Dimming of vision

  • Head, neck, or shoulder pain

  • Altered mentation

  • Weakness - Especially of the legs

  • Fatigue

  • Yawning

  • Slurred speech

  • Syncope

Some patients have fewer orthostatic symptoms. In 51% of patients with MSA, syncope is reported at least once. In 18% of patients with severe hypotension, more than 1 syncopal episode is documented. Because of dysautonomia-mediated baroreflex impairment and consequent debuffering, patients respond in an exaggerated fashion to drugs that raise or lower their BP.

Orthostatic hypotension must be distinguished from postural tachycardia syndrome, which is defined as an increase in heart rate of greater than 30 beats per minute (bpm) and maintained BP (absence of orthostatic hypotension).

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