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Case Reports
. 2023 Apr;33(2):205-208.
doi: 10.1007/s10286-023-00935-z. Epub 2023 Mar 7.

Baroreflex-sympathoneural without baroreflex-cardiovagal failure in neurogenic orthostatic hypotension

David S Goldstein  1 , Samantha Dill  2 , Patti Sullivan  2 , Edward Grabov  2 , Prashant Chittiboina  2
Affiliations
Case Reports

Baroreflex-sympathoneural without baroreflex-cardiovagal failure in neurogenic orthostatic hypotension

David S Goldstein et al. Clin Auton Res. 2023 Apr.

Abstract

We describe a patient with neurogenic orthostatic hypotension (nOH) after brainstem neurosurgery in whom baroreflex-cardiovagal function was normal despite baroreflex-sympathoneural failure. We also cite other conditions entailing differential alterations in the two efferent limbs of the baroreflex. Any condition involving nOH from selective loss of sympathetic noradrenergic innervation, interference with sympathetic pre-ganglionic transmission in the thoracolumbar spinal cord, sympathectomies, or attenuated intra-neuronal synthesis, storage, or release of norepinephrine would be expected to manifest with selective baroreflex-sympathoneural dysfunction. We advise caution in relying on indices of baroreflex-cardiovagal function for diagnosing nOH, since normal values for these indices do not exclude nOH.

Keywords: Baroreflex; Cardiovagal; Neurosurgery; Orthostatic hypotension; Sympathoneural.

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