Orthostatic Hypotension and Albuminocytologic Dissociation as Primary Manifestations of the Paraneoplastic Syndrome

Li, Jingjing; Yi, Li; Xing, Shihui; Zhang, Jian; Qiu, Baoshan; Fan, Yuhua

doi:10.1159/000493865

Cited by 4 publications

(3 citation statements)

References 10 publications

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“…50 Diabetes may be present in up to 40% of OH patients, as this is advancing age and chronic conditions, such as neurodegenerative diseases, hypertension, heart failure, diabetes, renal dysfunction, autoimmune diseases, and cancer. [19][20][21][22] The prevalence of age -dependent OH ranges from less than 5% in younger individuals (<50 years of age) to 20% and higher in those older than 70 years. 23,24 However, the majority of individuals who meet the OH criteria at screening are asymptomatic or unaware of the problem.…”

Section: Cardiovascular Risk Factors and Circulatory Compli-mentioning

confidence: 99%

Orthostatic hypotension and cardiovascular risk

Fedorowski¹,

Ricci²,

Sutton³

2019

Kardiol Pol

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Orthostatic hypotension (OH) is a cardinal sign of cardiovascular (CV) autonomic dysfunction as a result of autonomic nervous system failure to control the postural hemodynamic homeostasis. The proportion of individuals with OH increases with aging and chronic conditions, such as neurodegenerative diseases, hypertension, heart failure, diabetes, renal dysfunction, autoimmune diseases, and cancer. In individuals over 70 years of age, more than 20% can be affected. It is now increasingly recognized that there is a direct relationship between OH and each step of the CV disease continuum, eventually leading to end-stage heart disease and CV death. In particular, prevalent OH is associated with cardiac functional and structural remodeling, left ventricular hypertrophy, elevated levels of circulating markers of inflammation, increased intima-media thickness, subclinical atherosclerosis, and thrombosis. Beyond subclinical changes, the presence of OH independently predicts coronary events, stroke, atrial fibrillation, heart failure, and CV mortality. Furthermore, OH is associated with syncope, falls, and fragility fractures, presenting hurdles to be overcome in the delivery of the best management of CV risk factors. Taken together, OH heralds disruption of global circulatory homeostasis and flags overt autonomic dysfunction. The presence of OH is also an independent risk factor for mortality and CV disease; however, until now, the importance of this highly prevalent disorder has been given insufficient attention by clinicians and other healthcare providers. Consequently, more studies are needed to find effective treatment for this troublesome condition and to identify preventive measures that could reduce the burden of CV risk in OH and autonomic dysfunction.

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Section: Cardiovascular Risk Factors and Circulatory Compli-mentioning

confidence: 99%

Orthostatic hypotension and cardiovascular risk

Fedorowski¹,

Ricci²,

Sutton³

2019

Kardiol Pol

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“…Although the negative Schellong test result did not confirm orthostatic hypotonia, the whole clinical picture supported the diagnosis. The described orthostatic disorders might also be due to prolonged stay in a recumbent position, insufficient fluid intake, the use of hypotensive drugs, hypochromic anemia, or as a paraneoplastic syndrome [28,29]. However, the onset of those symptoms after having had COVID-19 suggests the possible viral etiology of the syndrome.…”

Section: Discussionmentioning

confidence: 99%

Orthostatic hypotonia as a probably late sequela of SARS-CoV-2 infection in a patient provided with palliative home care: a case report

2022

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Background The SARS-CoV-2 pandemic has become a challenge for the entire healthcare system. Treatment for COVID-19 includes casual and symptomatic management in the acute phase of the disease and focuses on the treating early complications of the disease. Long-term health consequences of the infection have not yet been fully identified. A special group of patients with comorbidities, including neoplastic disease for whom the interpretation and management of symptoms is a major challenge. Case presentation In this case report, we present a 73-year-old woman with recently diagnosed gastric adenocarcinoma in whom we diagnosed orthostatic hypotonia in the aftermath of SARS-CoV-2 infection. We administered thiethylperazine maleate 6.5 mg daily. Additionally, we advised the patient to slowly lift from the recumbent position, raise the headboard, take meals in small portions, and increase fluid intake. These pharmacological and nonpharmacological measures resulted in sustained relief of dizziness and nausea. Conclusions The occurrence of orthostatic hypotonia seems a possible late sequela of SARS-CoV-2 infection, and simple measures appeared sufficient to achieve sustained symptom control.

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“…We conducted a search for similar cases using "anti-Hu syndrome" as a keyword, but only a few cases or clearly related pathological findings were found. OH is rarely found as a comorbidity associated with subacute sensory neuronopathy, and to date, only two cases of OH with albuminocytologic dissociation have been reported in patients with paraneoplastic syndrome [8].…”

Section: Discussionmentioning

confidence: 99%

Paraneoplastic Neurologic Syndrome in Small Cell Lung Carcinoma

Lee,

Ku,

Jung

et al. 2023

J Electrodiagn Neuromuscul Dis

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A 54-year-old male smoker, previously in good health, was admitted to the hospital due to a tingling sensation in his upper and lower extremities. He reported difficulty walking due to a loss of balance and numbness, leading to an initial diagnosis of chronic inflammatory demyelinating polyneuropathy. Brain and spine magnetic resonance imaging, along with needle electromyography, yielded inconclusive findings. However, a nerve conduction study indicated a length-dependent pattern of sensory-dominant polyneuropathy. A cerebrospinal fluid study did not reveal any specific findings in terms of cell numbers, proteins, or immune tests. Following hospitalization, the patient reported progressive dizziness upon standing, leading to a preliminary diagnosis of orthostatic hypotension. However, a positive anti-Hu autoantibody test, along with chest computed tomography and positron emission tomography scans, revealed a mass in the left interlobar lymph node, suggestive of lung cancer. An endoscopic biopsy confirmed the presence of small cell lung cancer (SCLC). The patient underwent chemo-radiation treatment for the SCLC and immunoglobulin therapy for sensory ganglionopathy. As a result, a definitive diagnosis of paraneoplastic neurologic syndrome was made. Although such cases are rare, our observations suggest that symptoms of dysautonomia and sensory ganglionopathy may be associated with the production of anti-Hu antibodies.

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Orthostatic Hypotension and Albuminocytologic Dissociation as Primary Manifestations of the Paraneoplastic Syndrome

Cited by 4 publications

References 10 publications

Orthostatic hypotension and cardiovascular risk

Orthostatic hypotension and cardiovascular risk

Orthostatic hypotonia as a probably late sequela of SARS-CoV-2 infection in a patient provided with palliative home care: a case report

Paraneoplastic Neurologic Syndrome in Small Cell Lung Carcinoma

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