Consensus Statement

1
Consensus Statement

• on the definition of
• Orthostatic hypotension
• Pure autonomic failure
• Multiple system atrophy

American Autonomic Society American Academy of
Neurology Neurology 1996 461470
2
Orthostatic Hypotentiondefinition

• reduction of
• systolic BP of at least 20 mm Hg, or
• diastolic BP of at least 10 mm Hg
• within 3 minutes of standing (some may
• take more than 10 minutes)
• similar drop in blood pressure within 3 minutes
  in a head-up tilt table test at an angle of at
  least 60 degrees

Neurology 1996 461470
3
Orthostatic Hypotentionsymptoms

• symptoms develop on assuming the erect posture
• lightheadedness, dizziness, blurred vision,
  weakness, fatigue, cognitive impairment, nausea,
  palpitations, tremulousness, headache, neck ache
• some patients may be asymptomatic

Neurology 1996 461470
4
Orthostatic Hypotentionconfounding variables

• food ingestion medications
• hypertension gender / sex
• time of day
• state of hydration
• recent recumbency
• ambient temperature
• postural deconditioning

Neurology 1996 461470
5
Pure Autonomic Failuredefinition

• An idiopathic sporadic disorder characterized by
  OH usually with evidence of more widespread
  autonomic failure
• no other neurologic features present
• characteristically with reduced supine plasma
  norepinephrine levels

Neurology 1996 461470
6
Multiple System Atrophy (MSA)

• a sporadic, progressive, adult onset disorder
  characterized by any combination of
• autonomic dysfunction
• parkinsonism
• ataxia
• parkinsonian and cerebellar features commonly
  occur in combination

Neurology 1996 461470
7
Multiple System Atrophy (MAS) clinical features

• Parkinsonism
• bradykinesia with rigidity /- tremor
• usually with a poor or unsustained motor response
  to chronic levodopa therapy
• striatonigral degeneration - when parkinsonian
  features predominate

Neurology 1996 461470
8
Multiple System Atrophy (MAS) clinical features

• Cerebellar or corticospinal signs
• sporadic olivopontocerebellar atrophy - when
  cerebellar features predominate

Neurology 1996 461470
9
Multiple System Atrophy (MAS) clinical features

• Autonomic failure
• orthostatic hypotension, impotence, urinary
  incontinence or retention, usually preceding or
  within 2 years after the onset of the
  motorsymptoms
• Shy-Drager syndrome - when autonomic failure
  predominates

Neurology 1996 461470