Siddhartha Lieten1,2, Aziz Debain3,4, Bert Bravenboer3,4,5, Tony Mets3,4. 1. Department of Geriatrics, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, B-1090, Brussels, Belgium. Siddhartha.Lieten@uzbrussel.be. 2. Frailty in Aging (FRIA) investigation group, Faculty of Medicine & Pharmacy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, B-1090, Brussels, Belgium. Siddhartha.Lieten@uzbrussel.be. 3. Department of Geriatrics, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, B-1090, Brussels, Belgium. 4. Frailty in Aging (FRIA) investigation group, Faculty of Medicine & Pharmacy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, B-1090, Brussels, Belgium. 5. Departments of Endocrinology & Clinical Pharmacology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, B-1090, Brussels, Belgium.
Abstract
BACKGROUND: Orthostatic hypotension (OH) in geriatric patients frequently involves a component of autonomic failure (AF). The combination of OH with nocturnal hypertension (NHT) is indicative of AF, which is described as pure (PAF), when neurologic symptoms are absent, or as multisystem atrophy (MSA), when combined with motor disturbance (Parkinsonism or Parkinson disease). CASE PRESENTATION: An 87-year-old man presented with long-lasting OH. He frequently fell, causing several fractures, and he developed heart failure. Blood pressure (BP) registration revealed a reversal of the day-night rhythm with NHT. An 18-FDG PET brain CT scan showed cerebellar hypometabolism, indicating MSA. CONCLUSIONS: This case demonstrates the use of continuous BP registration in geriatric patients with OH for diagnosing NHT. It illustrates the usefulness of 18-FDG PET brain CT scan to specify the nature of the AF. The case also illustrates the difficulty of managing the combination of OH and NHT.
BACKGROUND:Orthostatic hypotension (OH) in geriatric patients frequently involves a component of autonomic failure (AF). The combination of OH with nocturnal hypertension (NHT) is indicative of AF, which is described as pure (PAF), when neurologic symptoms are absent, or as multisystem atrophy (MSA), when combined with motor disturbance (Parkinsonism or Parkinson disease). CASE PRESENTATION: An 87-year-old man presented with long-lasting OH. He frequently fell, causing several fractures, and he developed heart failure. Blood pressure (BP) registration revealed a reversal of the day-night rhythm with NHT. An 18-FDG PET brain CT scan showed cerebellar hypometabolism, indicating MSA. CONCLUSIONS: This case demonstrates the use of continuous BP registration in geriatric patients with OH for diagnosing NHT. It illustrates the usefulness of 18-FDG PET brain CT scan to specify the nature of the AF. The case also illustrates the difficulty of managing the combination of OH and NHT.
Authors: Lucy Norcliffe-Kaufmann; Horacio Kaufmann; Jose-Alberto Palma; Cyndya A Shibao; Italo Biaggioni; Amanda C Peltier; Wolfgang Singer; Phillip A Low; David S Goldstein; Christopher H Gibbons; Roy Freeman; David Robertson Journal: Ann Neurol Date: 2018-03-10 Impact factor: 10.422
Authors: Frank J Wolters; Francesco U S Mattace-Raso; Peter J Koudstaal; Albert Hofman; M Arfan Ikram Journal: PLoS Med Date: 2016-10-11 Impact factor: 11.069