Cerebral
A. Sahib El-Radhi in Paediatric Symptom and Sign Sorter, 2019
In an infant with cerebral haematoma, child abuse should be considered. Children may present with irritability, vomiting, bulging fontanelle and focal seizure. Compared to adults, children have higher brain water content, the size of the head is relatively larger than the rest of the body, and vasculature is easily disrupted, hence the higher risk of epidural and subdural haematoma. Syncope is by far the most common cause with a lifetime incidence of about 40%. Orthostatic hypotension denotes fall of blood pressure (BP) on standing. Neurogenic orthostatic hypotension is due to impaired sympathetic activation with a fall in BP with little or no increase in heart rate. In neonatal seizures, subsequent developmental delay, cerebral palsy, epilepsy and death are related to low Apgar scores at 5 minutes. Focal seizures are often more serious than generalised seizures. Focal seizures can be the presenting features of herpes encephalitis or cerebral tumours.
Demographics, Biology, and Physiology
K. Rao Poduri in Geriatric Rehabilitation, 2017
Biological causes that are age related include cardiac and pulmonary function, muscle strength, vital capacity, orthostatic changes, peripheral resistance, vital capacity, minute volume, and aerobic capacity. Psychological factors include beliefs about self, recovery, and rehabilitation in addition to delayed learning pace needing more repetitions. In the social arena, less frequent referrals to needed rehabilitative care, negative views of ageism, financial barriers, and self-ageism all impact the older adults in coping with disability and obtaining rehabilitation. The onset of aging along with the rate and extent of progression is very individualized and differs from individual to individual. Depending on the functional capacity, the biological age is the metric for the biology of aging, and not the chronological age. There are evolutionary, genetic, physiologic, and other theories of aging. The adrenal glands respond to aging with a decrease in aldosterone secretion that can explain the orthostatic hypotension experienced by aging population.
Autonomic dysfunction
Andrew Lees in Parkinson's Disease in the Older Patient, 2018
Autonomic symptoms in Parkinson's disease (PD) were first reported in 1817 by James Parkinson himself. He described abnormalities of salivation and sweating, and dysfunction of the alimentary tract and urinary bladder. This chapter covers the differential diagnosis of dysautonomia in PD, and explains the investigations used to measure autonomic function in both clinical and research settings. It discusses the clinical implications of dysautonomia in PD and treatment options. Autonomic dysfunction is due to primary and secondary disorders. There are three primary causes of autonomic dysfunction in patients with definite extrapyramidal signs: idiopathic PD with autonomic failure, multiple system atrophy (MSA) and Lewy body dementia. Antiparkinsonian medications and other drugs may interfere with autonomic function. Orthostatic hypotension (OH) is a cardinal feature of autonomic dysfunction. Biochemical and pharmacological investigations are sometimes used in researching dysautonomia in PD, but are rarely required in the clinical setting.
Identification and management of orthostatic hypotension in older and medically complex patients
Published in Expert Review of Cardiovascular Therapy, 2012
Orthostatic hypotension is defined as a drop in systolic blood pressure (BP) of at least 20 mmHg or of diastolic BP of at least 10 mmHg within 3 min of standing. It is uncommon in the healthy elderly. However, it occurs in 30–50% of elderly persons with known risk factors and is another example of a multifactorial geriatric syndrome similar to falls and delirium. Most patients with orthostatic hypotension either have no symptoms or atypical symptoms, and therefore, screening BPs should be taken in all patients with risk factors. The treatment approach is not standardized but a stepped-care algorithm is presented that is likely to be successful for many patients. Future studies need to focus on the potential benefits of screening and treating patients with this disorder.
Droxidopa for neurogenic orthostatic hypotension
Published in Expert Opinion on Orphan Drugs, 2015
Introduction: Neurogenic orthostatic hypotension is a disabling manifestation of autonomic failure seen in disorders such as multiple system atrophy, pure autonomic failure, Lewy body disease, Parkinson’s disease, autonomic neuropathies and dopamine β-hydroxylase deficiency. Areas covered: Droxidopa is an orally administered norepinephrine prodrug that was approved in the US in the year 2014 for the treatment of neurogenic orthostatic hypotension. This review examines the published pharmacodynamic, pharmacokinetic, safety and efficacy data including the results of phase II and phase III studies of droxidopa. Expert opinion: Droxidopa has been shown to have measurable clinical benefit in reducing the symptoms of neurogenic orthostatic hypotension, in particular postural lightheadedness despite its modest pressor effect, and it has been well-tolerated. As studies to date have demonstrated only short-term efficacy and safety, longer-term studies are needed to establish the durability of efficacy. An important safety concern is droxidopa’s potential to exacerbate supine hypertension, which commonly occurs in neurogenic orthostatic hypotension. Direct comparison studies are needed with other treatment approaches for neurogenic orthostatic hypotension.
Refractory orthostatic hypotension in a patient with a spinal cord injury: Treatment with droxidopa
Published in The Journal of Spinal Cord Medicine, 2018
Eva Canosa-Hermida, Cristina Mondelo-García, María Elena Ferreiro-Velasco, Sebastián Salvador-de la Barrera, Antonio Montoto-Marqués, Antonio Rodríguez-Sotillo, José Ramón Vizoso-Hermida
Context: Orthostatic hypotension (OH) is a common complication in patients with a spinal cord injury, mainly affecting complete injuries above neurological level T6. It is generally more severe during the acute phase but can remain symptomatic for several years. Findings: A 65-year-old male with a grade ASIA A post-traumatic cervical spinal cord injury, at neurological level C4, presenting with symptomatic refractory OH. Increased blood pressure (BP) levels and an overall clinical improvement was observed after administering an increasing dose of droxidopa. Treatment was started at a dose of 100 mg twice daily (bid), one to be taken upon rising in the morning and another one in the afternoon, at least three hours before bedtime. According to the patient's symptomatic response, each individual dose was increased by 100 mg at 48-hour intervals. Both increased mean BP levels and a subjective symptomatic improvement were evidenced at a dose of 300 mg bid. Clinical relevance: Treatment with droxidopa increases BP levels and improves symptoms related to refractory OH using all physical and pharmacological measures available. It could therefore constitute an effective alternative treatment for OH in patients with a spinal cord injury.
Related Knowledge Centers
- Blood Pressure
- Dizziness
- Hypotension
- Postural Orthostatic Tachycardia Syndrome
- Syncope
- Jh
- Neurocardiogenic Syncope