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May 1960

A Neurological Syndrome Associated with Orthostatic Hypotension: A Clinical-Pathologic Study

Author Affiliations

Bethesda, Md.
From the Medical Neurology Branch, National Institute of Neurological Diseases and Blindness, National Institutes of Health, U.S. Public Health Service, Department of Health, Education, and Welfare.
Now in the Department of Neurology, Baylor University College of Medicine Houston, Texas (Dr. Drager).

AMA Arch Neurol. 1960;2(5):511-527. doi:10.1001/archneur.1960.03840110025004

Introduction  Perhaps, with the exception of adrenal insufficiency,1,2 postural hypotension is coincident with involvement of the nervous system.3,4 Many such cases are secondary to disorders like diabetes, syphilis, and other systemic diseases, which also affect the central or peripheral nervous system.4-12 On 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

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