Li Ya, Wang Min, Liu Xiang-Lan, Ren Ya-Fei, Zhang Wen-Bin
Department of Cardiovascular Diseases, Sir Run Run Shaw Hospital, College of Medicine of Zhejiang University, Hangzhou 310016, Zhejiang Province, China.
Department of Rehabilitation Medicine, Qilu Institute of Technology, Jinan 250200, Shandong Province, China.
World J Clin Cases. 2021 Jul 26;9(21):6073-6080. doi: 10.12998/wjcc.v9.i21.6073.
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.
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.
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.
晕厥的诊断具有挑战性，且医疗成本高昂。神经源性直立性低血压（nOH）作为晕厥的一个病因尚未得到充分认识。我们回顾了一例帕金森病患者由nOH引起的晕厥病例。
我们描述了一例帕金森病患者由nOH引起的晕厥病例并复习相关文献。一名70岁帕金森病男性患者血压控制不佳达1个月，血压范围为70/40至220/112 mmHg，且有一次起床后意识丧失持续数分钟。动态血压监测显示夜间高血压（高达217/110 mmHg）及晨起直立性低血压（低至73/45 mmHg）。平卧位转站立位血压测量显示，从仰卧位站立3分钟后血压从173/96 mmHg降至95/68 mmHg。诊断为伴有卧位高血压的nOH。在治疗过程中，米多君未能改善症状。最终，通过加强锻炼、减少白天卧床时间及起床前饮水等简单策略，患者血压得以稳定。
nOH是晕厥的病因之一。动态血压监测是诊断nOH的一种经济有效的方法，非药物措施仍是主要的治疗方法。
