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August 1968

Centrally Mediated Orthostatic Hypotension: Report of Cases

Author Affiliations

From Case Western Reserve University School of Medicine, Department of Medicine, Division of Neurology (Drs. Martin, Travis, and van den Noort) and the Department of Physiology (Dr. Travis) and University Hospitals (Drs. van den Noort and Travis), Cleveland. Dr. Martin is now at the University of Rochester Medical School, Endocrine Unit, Rochester, NY.

Arch Neurol. 1968;19(2):163-173. doi:10.1001/archneur.1968.00480020049005

ORTHOSTATIC hypotension may be primary or secondary. The clinical syndrome of primary idiopathic orthostatic hypotension is characterized by inability to sustain standing blood pressure without the development of pallor or of tachycardia.1 Other findings include anhidrosis, impotence, urinary urgency or retention, alternating constipation and diarrhea, and a variety of disturbances directly pointing to disease of the central nervous system.2 Evidences of central nervous system disease include dysarthric or monotonous speech, diplopia, pupillary irregularities, vertigo, rigidity, tremor, cerebellar ataxia, and incontinence.2

Orthostatic hypotension, as a secondary phenomenon, occurs in a wide variety of disease states and after bed rest. Interest in orthostatic hypotension has been stimulated by its development after space flights.3 Sustained orthostatic hypotension has been described in neuropathies (diabetic,4 porphyric,5 nutritional), in myasthenia gravis,6 in paraplegia of varied causes, in Wernicke's encephalopathy,7,8 in combined systems disease,9 in tumors of

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