Postural tachycardia syndrome in syringomyelia: response to fludrocortisone and beta-blockers.

Abstract

Orthostatic intolerance is occasionally reported by patients with syringomyelia and is usually attributed to vestibular symptoms or neurogenic orthostatic hypotension. Postural tachycardia syndrome has not been previously described in syringomyelia. A patient with long-standing syringomyelia and a Chiari type I anomaly developed disabling "panic-like" attacks associated to orthostatic intolerance five years after posterior fossa decompression and shunting of the syrinx. A head-up tilt test showed an early phase of postural orthostatic tachycardia followed by progressive arterial hypotension and bradycardia as seen in neurally mediated syncope. A magnetic resonance imaging scan showed a collapsed syrinx from the 3rd cervical to the 12th thoracic vertebra without syringobulbia. Fludrocortisone and beta-blockers led to resolution of symptoms. Partial sympathetic denervation of the legs in syringomyelia might explain the occasional occurrence of postural tachycardia syndrome. Postural tachycardia syndrome may be included as a possible cause of orthostatic symptoms in syringomyelia patients.

• Authors: M Nogués, R Delorme, D Saadia, K Heidel, E Benarroch
• Journal: Clinical autonomic research : official journal of the Clinical Autonomic Research Society (Clin Auton Res) Vol. 11 Issue 4 Pg. 265-7 (Aug 2001) ISSN: 0959-9851 [Print] Germany
• PMID: 11710800 (Publication Type: Case Reports, Journal Article)

Chemical References

• Adrenergic beta-Antagonists
• Anti-Inflammatory Agents
• Fludrocortisone

Topics

• Adrenergic beta-Antagonists (therapeutic use)
• Anti-Inflammatory Agents (therapeutic use)
• Autonomic Nervous System (physiopathology)
• Female
• Fludrocortisone (therapeutic use)
• Humans
• Magnetic Resonance Imaging
• Middle Aged
• Posture (physiology)
• Syringomyelia (complications, physiopathology, psychology)
• Tachycardia (drug therapy, etiology, physiopathology)