Pure Autonomic Failure with Asymptomatic Hypertensive Urgency: A Case Report and Literature Review

• Main Authors: Alwaleed Aljohar, Taim Muayqil, Abdulrahman Aldeeri, Anwar Jammah, Ahmad Hersi, Khalid Alhabib
• Format: Article
• Language: English
• Published: Karger Publishers 2018-12-01
• Series: Case Reports in Neurology
• Subjects: Orthostatic hypotension; Pure autonomic failure; Supine hypertension; Ambulatory blood pressure monitoring; Saudi Arabia
• Online Access: https://www.karger.com/Article/FullText/495605

We report the case study of a 70-year-old gentleman who presented with isolated, slowly progressive dizziness after prolonged standing and was eventually diagnosed with pure autonomic failure. Initially, his symptoms improved with the use of midodrine and fludrocortisone, but gradually became refractory and disabling. Despite multiple therapeutic interventions, his symptoms persisted along with worsening supine hypertension. We discuss the challenges faced in the treatment of an uncommon condition and discuss the clinical utility of performing serial 24-h ambulatory monitoring to detect subclinical blood pressure fluctuations.