Symptoms associated with orthostatic hypotension in pure autonomic failureand multiple system atrophy

The symptoms caused by or relating to orthostatic hypotension (over 20 mmHg systolic blood pressure) were evaluated using a questionnaire in 72 patien ts with primary chronic autonomic failure, 32 of whom had pure autonomic fa ilure (PAF, and 40 multiple system atrophy (MSA). The most common posturall y related symptoms were dizziness (84% PAF, 83% MSA), syncope (91% PAF, 45% MSA), visual disturbances (75% PAF, 53% MSA) and suboccipital/paracervical 'coat-hanger' neck pain (81% PAF, 53% MSA). Chest pain occurred mainly in patients with PAF (44% PAF, 13% MSA). Improvement occurred with sitting or lying flat. Non-specific symptoms (weakness, lethargy and fatigue) were com mon in both groups (91% PAF, 85% MSA); six patients tone PAF, five MSA) had these symptoms only. Postural symptoms (mainly dizziness and neck pain) we re worse in the morning and with warm temperature, straining, exertion, arm movements and food ingestion; they were more common in PAF. Compensatory a utonomic symptoms, such as palpitations and sweating, did not occur in eith er group. In conclusion, orthostatic hypotension caused symptoms of cerebra l hypoperfusion (syncope, dizziness and visual disturbances); neck pain, pr esumably due to muscle hypoperfusion, also occurred frequently. These sympt oms were exacerbated by various factors in daily life and were relieved by returning to the horizontal. Non-specific symptoms (such as fatigue) also w ere common. In MSA, despite substantial orthostatic hypotension, fewer pati ents had syncope, visual disturbance and neck pain; the reasons for this ar e unclear. Lack of these features does not exclude the need to assess and i nvestigate orthostatic hypotension and possible autonomic failure.