1/7. Hormonal and cardiovascular reflex assessment in a female patient with pure autonomic failure.We report the case of a 72-year-old female with pure autonomic failure, a rare entity, whose diagnosis of autonomic dysfunction was determined with a series of complementary tests. For approximately 2 years, the patient has been experiencing dizziness and a tendency to fall, a significant weight loss, generalized weakness, dysphagia, intestinal constipation, blurred vision, dry mouth, and changes in her voice. She underwent clinical assessment and laboratory tests (biochemical tests, chest X-ray, digestive endoscopy, colonoscopy, chest computed tomography, abdomen and pelvis computed tomography, abdominal ultrasound, and ambulatory blood pressure monitoring). Measurements of catecholamine and plasmatic renin activity were performed at rest and after physical exercise. Finally the patient underwent physiological and pharmacological autonomic tests that better diagnosed dysautonomia.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/7. Chiari I malformation with or without syringomyelia and pregnancy: case studies and review of the literature.women with Chiari I malformation with or without syringomyelia are of particular concern because of the potential risk of increased intracranial pressure during pregnancy and delivery. The following questions are most often asked in the clinical setting: Is it safe to have a planned pregnancy? Will the symptoms become worse or recur during pregnancy and will the baby be normal? Seven patients with Chiari I malformation, with and without syringomyelia, submitted checklists of self-reported symptoms experienced during pregnancy, labor, and postpartum. Seven patients with Chiari I malformation with and without syringomyelia were queried for symptoms during pregnancy, labor, and postpartum. None of the patients reported significant increase or recurrence of Chiari-related symptoms during delivery or postpartum. Four of the women had epidural anesthesia for delivery and reported no related symptoms. This series represents a small number of women with Chiari I malformation who had uncomplicated pregnancy, labor, and delivery.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/7. Drop attacks secondary to superior canal dehiscence syndrome.Two patients with unprovoked drop attacks were found to have dehiscence of the superior semicircular canal on CT of the temporal bone. Both had conductive hearing loss, preservation of stapedius reflex, and abnormal vestibular evoked myogenic potentials. Neither had sound- or pressure-induced nystagmus. Repair of the dehiscence in one case stopped the drop attacks, supporting a causal relationship between the dehiscence and the drop attacks.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/7. Postural dizziness and transient hypotension in two healthy teenagers.Neurocardiovascular control during postural change was investigated in two teenage females with complaints of dizziness almost immediately on standing up. blood pressure and heart rate were monitored continuously with a Finapres device. On standing there was a brief but marked fall in blood pressure between 5-10 s after the onset of the manoeuvre. The maximum fall in systolic and diastolic blood pressure was 65 mmHg and 40 mmHg respectively in the first subject, and 58 mmHg and 29 mmHg respectively in the second subject. In both, postural tachycardia was present after 1-2 min of standing with heart rate increasing by up to 39 beats/min in the first subject and 60 beats/min in the second subject. On a follow-up examination 3 years later these changes had disappeared in the first subject while they persisted in the second subject, when she was studied two years later. We conclude that in these patients initial postural dizziness is related to an excessive fall in blood pressure upon standing.- - - - - - - - - - ranking = 4keywords = pressure (Clic here for more details about this article) |
5/7. Otologic manifestations of pseudotumor cerebri.Otologic manifestations of pseudotumor cerebri heightened awareness of pseudotumor cerebri and its varied subtle presentations will allow for a more expedient diagnosis by the otolaryngologist. pseudotumor cerebri is defined as increased intracranial pressure and papilledema without a mass lesion or obstruction of the ventricular system. Presenting symptoms most commonly are headache and visual dysfunction. However, patients may present with associated symptoms of tinnitus, dizziness and hearing loss. These patients may be seen first by the otolaryngologist. Fourteen patients with a diagnosis of pseudotumor cerebri are reviewed. Nine of the 14 patients had neurotologic symptoms during the course of their evaluation. pseudotumor cerebri is a diagnostic challenge. Keys to diagnosis are a high index of suspicion, careful history and funduscopic examination in patients with unexplained neuro-otologic symptoms.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/7. Primary dysfunction of the afferent limb of the arterial baroreceptor reflex system in a patient with severe supine hypertension and orthostatic hypotension.A 33 year old man with a history of recurrent episodes of orthostatic dizziness since adolescence was noted to have a supine blood pressure of 200/120 mm Hg and a standing blood pressure of 90/60 mm Hg. Results of extensive laboratory studies for secondary hypertension were negative. Studies of the autonomic nervous system function revealed normal plasma catecholamines, cold pressor test and response to 4 minute 30% of maximal static handgrip contraction and an appropriate increase in heart rate on intravenous injection of atropine. In contrast, the heart rate response to phenylephrine and sodium nitroprusside infusion, carotid massage and graded neck suction with an airtight chamber was very abnormal, indicating marked dysfunction of the afferent limb of the arterial baroreceptor reflex system. methyldopa decreased the supine hypertension and increased the standing blood pressure.- - - - - - - - - - ranking = 3keywords = pressure (Clic here for more details about this article) |
7/7. Post-exertion dizziness as the sole presenting symptom of autonomic failure.An otherwise fit young man, leading an active life, whose only complaint at presentation was dizziness after extreme exertion is described. He was found later to have postural and exercise induced hypotension. Subsequently, he developed typical symptoms of autonomic failure, with postural dizziness, urinary abnormalities, and erectile failure. Progression of autonomic failure was documented on testing. A fall in blood pressure during or after exercise has been reported previously in pure autonomic failure, but a presentation with exercise induced symptoms alone is unusual.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |