Neurogenic orthostatic hypotension with Parkinson's disease as a cause of syncope: A case report

doi:10.12998/wjcc.v9.i21.6073

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World Journal of Clinical Cases

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Case Report

World J Clin Cases. Jul 26, 2021; 9(21): 6073-6080
Published online Jul 26, 2021. doi: 10.12998/wjcc.v9.i21.6073

Neurogenic orthostatic hypotension with Parkinson's disease as a cause of syncope: A case report

Ya Li, Min Wang, Xiang-Lan Liu, Ya-Fei Ren, Wen-Bin Zhang

Ya Li, Min Wang, Xiang-Lan Liu, Wen-Bin Zhang, Department of Cardiovascular Diseases, Sir Run Run Shaw Hospital, College of Medicine of Zhejiang University, Hangzhou 310016, Zhejiang Province, China

Ya-Fei Ren, Department of Rehabilitation Medicine, Qilu Institute of Technology, Jinan 250200, Shandong Province, China

Author contributions: Li Y and Ren YF reviewed the literature and contributed to manuscript drafting; Wang M and Liu XL were the patient’s cardiologists; Zhang WB was responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.

Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.

Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.

CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).

Corresponding author: Wen-Bin Zhang, PhD, Associate Chief Physician, Department of Cardiovascular Diseases, Sir Run Run Shaw Hospital, College of Medicine of Zhejiang University, No. 3 Qinchundong Road, Hangzhou 310016, Zhejiang Province, China. 3313011@zju.edu.cn

Received: March 18, 2021
Peer-review started: March 18, 2021
First decision: April 23, 2021
Revised: May 6, 2021
Accepted: May 15, 2021
Article in press: May 15, 2021
Published online: July 26, 2021
Processing time: 124 Days and 23.7 Hours

Abstract

BACKGROUND

Syncope presents with diagnostic challenges and is associated with high healthcare costs. Neurogenic orthostatic hypotension (nOH) as one cause of syncope is not well established. We review a case of syncope caused by nOH in a patient with Parkinson's disease.

CASE SUMMARY

We describe a case of syncope caused by nOH in Parkinson's disease and review the literature. A 70-year-old man with Parkinson's disease had uncontrolled blood pressure for 1 mo, with blood pressure ranging from 70/40 to 220/112 mmHg, and once lost consciousness lasting for several minutes after getting up. Ambulatory blood pressure monitoring indicated nocturnal hypertension (up to 217/110 mmHg) and morning orthostatic hypotension (as low as 73/45 mmHg). Seated-to-standing blood pressure measurement showed that the blood pressure dropped from 173/96 mmHg to 95/68 mmHg after standing for 3 min from supine position. A diagnosis of nOH with supine hypertension was made. During the course of treatment, Midodrine could not improve the symptoms. Finally, the patient's blood pressure stabilized with simple strategies by strengthening exercises, reducing the duration of lying in bed in the daytime, and consuming water intake before getting up.

CONCLUSION

nOH is one of the causes of syncope. Ambulatory blood pressure monitoring is a cost-effective method for its diagnosis, and non-pharmacological measures are still the primary management methods.

Keywords: Neurogenic orthostatic hypotension; Syncope; Supine hypertension; Ambulatory blood pressure monitoring; Non-pharmacological management; Case report

Core Tip: Syncope presents with diagnostic challenges and is associated with high healthcare costs. For syncope caused by a change in position, neurogenic orthostatic hypotension (nOH) should be considered to reduce missed diagnosis and misdiagnosis. Paying attention to comorbidities, such as Parkinson's disease and diabetes which could cause can autonomic dysfunction, also helps in the diagnosis of the cause of syncope. Ambulatory blood pressure monitoring can assist in diagnosing nOH. It is very challenging for clinicians to manage patients with nOH and supine hypertension. Increasing physical activity and reducing the amount of time in bed are still the primary management methods.