Neurogenic orthostatic hypotension with Parkinson's disease as a cause of syncope:A case report

BACKGROUND Syncope presents with diagnostic challenges and is associated with high healthcare costs. Neurogenic orthostatic hypotension(n OH) as one cause of syncope is not well established. We review a case of syncope caused by n OH in a patient with Parkinson’s disease.CASE SUMMARY We describe a case of syncope caused by n OH 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 mm Hg, and once lost consciousness lasting for several minutes after getting up. Ambulatory blood pressure monitoring indicated nocturnal hypertension(up to 217/110 mm Hg) and morning orthostatic hypotension(as low as 73/45 mm Hg). Seated-to-standing blood pressure measurement showed that the blood pressure dropped from 173/96 mm Hg to 95/68 mm Hg after standing for 3 min from supine position. A diagnosis of n OH 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.CONCLUSION n OH 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.