14th Congress of the European Federation of Neurological Societies
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Autonomic Failure and other presentations of Orthostatic Intolerance
Christopher J. Mathias
Christopher J. Mathias
London, United Kingdom  
Disclosure: Consultant, Chelsea Therapeutics
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Topic: Other
46 slide(s) – 00:20:32– English –2010-09-28
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This lecture will focus on autonomic causes of orthostatic intolerance, where a variety of manifestations occur while changing position from recumbency to standing upright. The various symptoms will be described; they usually resolve readily on return to the horizontal position. In addition to loss of consciousness they include manifestations resulting from decreased blood flow to various organs, especially those above the heart, such as the brain and cervical musculature. The aetiology of orthostatic intolerance will be described, to include non-autonomic causes, followed by neurogenic causes, with an emphasis initially on those resulting from damage to the autonomic nervous system, either due to disease (primary or secondary), drugs, trauma, or as recently recognised, immunological processes directed at specific autonomic receptors. Examples of each will be provided.
A newer classification of orthostatic intolerance caused by autonomic damage, based on prognosis, natural history and intervention, will also be considered.
In addition, autonomic causes of orthostatic intolerance where there is no damage to the autonomic nervous system, but with a transient, usually short lived, aberration in sympathetic or parasympathetic function, or both, will be described. These are more common than fixed damage to the autonomic nervous system and include autonomic (neurally) mediated syncope, which comprise vasovagal syncope, carotid sinus hypersensitivity and situational syncope. This lecture will focus on two other intermittent causes, both relatively recently recognised, which include initial orthostatic hypotension, and the Postural Tachycardia Syndrome (PoTS). The latter has various causes and associations, which will be described together with treatment strategies.
References: Mathias CJ. Autonomic Dysfunction. In: Neurology. A Queen Square Textbook. Eds. Clarke C, Howard R, Rossor M, Shorvon S. Wiley-Blackwell, 2009: 871-892.
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