• Annals of Clinical Neurophysiology
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• v.22 no.2
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• pp.75-81
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• 2020

This paper introduces new diagnostic criteria and differential diagnosis of orthostatic dizziness to help clinicians to diagnose hemodynamic orthostatic dizziness. Clinicians need to be able to discriminate hemodynamic orthostatic dizziness from other types of dizziness that are induced or aggravated when standing or walking. Measurements of the orthostatic blood pressure and heart rate are important when screening hemodynamic orthostatic dizziness. Detailed history-taking, a physical examination, and laboratory tests are essential for finding the cause of hemodynamic orthostatic dizziness. The differential diagnosis of hemodynamic orthostatic dizziness is crucial because it can be caused by various autonomic neuropathies.

• Annals of Clinical Neurophysiology
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• v.25 no.1
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• pp.27-31
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• 2023

Orthostatic dizziness is feeling dizzy or lightheaded when standing up. Hemodynamic orthostatic dizziness can be caused by autonomic dysfunction such as orthostatic hypotension or postural tachycardia syndrome. The interpretation of the autonomic function test results in patients with orthostatic dizziness is crucial for diagnosing and managing the underlying condition. The head-up tilt and Valsalva tests are especially important for evaluating adrenergic function in patients with hemodynamic orthostatic dizziness. However, it is important to note that autonomic function tests do not cover the entire diagnostic process, since their findings need to be considered along with the detailed history and physical examination results of the patient because various differential diagnoses exist for orthostatic dizziness. Ensuring appropriate treatment by interpreting the autonomic function test results can help to determine the improvement of and prevents falls from orthostatic dizziness.

• Annals of Clinical Neurophysiology
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• v.13 no.1
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• pp.61-63
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• 2011

Postural orthostatic tachycardia syndrome (POTS) is characterized by increased heart rate with preserved blood pressure on orthostatic stress. Many patients with postural orthostatic tachycardia syndrome can be misdiagnosed as neurosis, chronic fatigue or anxiety disorder. We report a patient with POTS who presented chronic dizziness and fatigue. In approaching to a patient with orthostatic or nonspecific chronic dizziness, the postural heart rate as well as blood pressure should be checked not to miss the diagnosis.

• Annals of Clinical Neurophysiology
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• v.11 no.1
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• pp.1-8
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• 2009

Orthostatic intolerance is defined as the development of various symptoms during standing that are relieved by recumbency. Postural tachycardia syndrome (POTS) is another nomenclature of orthostatic intolerance. POTS characterized by a heart rate increase ${\geq}30$ bpm from supine to standing or >120 bpm at standing without orthostatic hypotension. POTS is a heterogenous in presentation with various pathophysiologic mechanisms. Important mechanisms are hypovolemia, denervation, hyperadrenergic and deconditioning state. There are presented as lightheadness or dizziness, palpitations, presyncope, sense of weakness, tremulousness, shortness of breath. POTS are classified under 3 groups that are neuropathic, hyperadrenergic, and deconditioning POTS. Most patients can be improved from a pathophysiologically based regimen of management.

• The Korean Journal of Pain
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• v.26 no.3
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• pp.277-285
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• 2013

Background: Opioid analgesics are widely used to reduce postoperative pain and to enhance post-operative recovery. However, orthostatic intolerance (OI) induced by opioid containing intravenous patient controlled analgesia (IPCA) may hinder postoperative recovery. This study investigated factors that affect OI in patients receiving IPCA for postoperative pain control. Methods: OI was instantly evaluated at the time of first ambulation in 175 patients taking opioid containing IPCA after open and laparoscopic subtotal gastrectomies. Patients were classified as having OI if they experienced dizziness, nausea/vomiting, blurred vision, headache, somnolence and syncope. Factors contributing to OI were assessed with logistic regression analysis. Results: Out of 175 patients, 61 (52.6%) male and 44 (74.6%) female patients experienced OI at the time of first ambulation. The frequency of OI related symptoms were dizziness (97, 55.4%), nausea (46, 26.3%), headache (9, 5.1%), blurred vision (3, 1.7%) and vomiting (2, 1.1%). Significant risk factors for OI were gender (P=0.002) and total amount of opioids administered (P=0.033). Conclusions: The incidence of OI is significantly higher in male than in female patients and is influenced by the opioid dose.

• Journal of the Korean neurological association
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• v.36 no.4
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• pp.280-288
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• 2018

Vertigo/dizziness is a common complaint in patients who are seeking a primary health clinic. Vertigo is traditionally attributed to damage of the vestibular system. Many peripheral and central vestibular disorders are usually presented with vertigo. However, patients with benign paroxysmal positional vertigo (BPPV), a leading cause of vertigo, may present with postural lightheadedness, near faint, imbalance rather than true vertigo. On the contrary, patients with orthostatic hypotension may present with true spinning vertigo, not dizziness. Persistent postural perceptual dizziness, a second most common cause of dizziness (after BPPV), is mainly occurred after organic vestibular disorders such as BPPV or vestibular neuritis, and classified as a chronic functional vestibular disorder. This article describes non-vestibular disorders presenting dizziness and/or vertigos, which conditions may be misdiagnosed as structural vestibular disorders.

• Journal of Medicine and Life Science
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• v.16 no.3
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• pp.96-100
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• 2019

Postural tachycardia syndrome (POTS) is common, although not so well-known variant of cardiovascular autonomic disorder characterized by an excessive heart rate increase on standing. POTS is probably underdiagnosed due to the heterogeneity in both presentation and etiology. This study aimed to evaluate the clinical and autonomic features in patients with POTS. We reviewed the medical records of patients with POTS. Medical records include onset age, sex, presenting symptoms, body mass index (BMI) and prognosis. All patients had an autonomic function and laboratory tests. Ninety-nine patients met the inclusion criteria for POTS (51.5% male; mean±SD age, 20.0±9.7 years; mean±SD, BMI 21.9±3.9). Common presenting symptoms were a brief loss of consciousness, dizziness, blurred vision and headache. Autonomic function tests showed abnormal quantitative sudomotor axon reflex testing in 20 patients of 99 POTS patients. The abnormal post-ganglionic sympathetic sudomotor function is generally considered to reflect a neuropathic form of POTS. In treatments, 83 patients were treated by non-pharmacological management including lifestyle changes and 16 patients required the initiation of pharmacological therapies. Most patients with POTS showed a relatively favorable prognosis. POTS is a chronic disease with a substantial subset of patients recovering within a few years after the initial presentation. Future efforts should focus on better understanding of POTS pathophysiology and designing randomized controlled trials for the selection of more effective therapy.