What Neurological Problems Cause Orthostatic Hypotension & Is It A Disability?

Orthostatic hypotension is the abrupt pressure drop, sometimes up to critical levels. The phenomenon develops both as chronic, and in ordinary, quite healthy people under certain conditions (prolonged stress, being in one position without movement, sleep, etc.).

The mechanism of development of orthostatic hypotension lies in a sharp outflow of blood from the brain and cerebral structures when rising from a lying or sitting position. This is possible due to hemodynamic disturbances in various pathologies, both cardiac and extracardiac origin (orthostasis is the vertical position of the body).

Frequent culprits are heart failure, metabolic and lipid metabolism disorders, a lack of hypertensive substances in the body with adrenal diseases, etc.

The disease rarely provokes health and life-threatening consequences, but a similar scenario is possible. Therefore, neglecting treatment, hoping that the pathology itself will recede, is not worth it.(1)

What Neurological Problems Cause Orthostatic Hypotension?

Patients with heart valve disease, heart failure, and heart attack may experience orthostatic hypotension. However, certain neurological disorders can also cause this condition. Examples include amyloidosis, Parkinson’s disease, Shy-Drager syndrome (or multiple system atrophy) and other involuntary neurological disorders. These conditions hamper proper blood flow through the blood vessels leading to orthostatic hypotension.

The neurological form occurs in almost 60% of cases, which makes it the main cause in the frequency of clinical situations. It is caused by neurocirculatory disorders due to a change in the nature of the work of the sympathetic and parasympathetic nervous system. The mechanisms are sometimes so complex that it is impossible to understand.(2)

Is Orthostatic Hypotension A Disability?

Orthostatic hypotension may cause severe disability, and patients experience dizziness, dizziness, fainting, and other problems that can have a profound negative impact on daily life that requires standing or walking.

If the symptoms of this disorder severely affect your ability to work, you may be eligible for social security disability benefits. Autonomic nervous disorders describe any disease that affects the autonomic nervous system.(3)(4)

Factors Causing Orthostatic Hypotension

Malnutrition: The deficiency of B vitamins affects the condition of the heart and blood vessels, as well as the composition and quantitative and qualitative characteristics of the blood. Most often, malnutrition and nutritional factors are generally found in young women who monitor their appearance. Forced factors are also possible: for certain social reasons. Anorexia all the more leads to this consequence.

Varicose Veins Of The Lower Extremities: At first glance, it seems strange but everything is within the framework of logic. As a result of varicose veins of the lower extremities, blood stagnation occurs. The volume of circulating hematological fluid remains the same, but not all blood is involved in the hemodynamic process. Hence the decrease in blood pressure until the process normalizes.

Neuropathies Of Various Etiologies: Including hepatic encephalopathy, impaired neurocirculatory function, etc. the reasons for orthostatic hypotension, in this case, lie in the violation of the regulation of vascular tone at the highest level: the “orders” are given by the nervous system, which is not at all in good condition to command. Similar phenomena occur in diabetes and hypothyroidism.

Brain Tumors Of Various Types And Localizations: Especially often expressed violations of the regulation of blood pressure give gliomas of the brain stem, germinomas, large pituitary adenomas that press on the hypothalamus and others. A mass effect is created: neoplasia artificially stimulates brain tissue to give false signals, sometimes chaotic.

Another Significant Reason Is Cardiac Pathologies: Including congenital and acquired malformations of the organ, heart failure, diseases associated with myocardial inflammation.

Infectious Pathologies: Here we are talking not only and not so much about common colds, but about severe pathologies of bacterial and viral origin, for example, about chronic tuberculosis. The body gives all its energy to fight infection. Also, the penetration of toxins produced by mycobacteria into the structures of the brain occurs. Hence the false stimulation of the hypothalamus and special centers that cause an induced decrease in blood pressure.

Thromboembolism: At the first moment, it is accompanied by arterial hypotension. It subsequently ends with acute tissue ischemia and death in a short time.

Violations Of The Endocrine Profile: This also affects the change in the nature of the work of the adrenal cortex (Addison’s disease, etc.), insufficient synthesis of specific substances of the thyroid gland (hypothyroidism). This is the second most common cause of orthostatic hypotension in people of all ages and genders.

  • Dehydration
  • Hypothalamic syndrome.
  • Iron deficiency anemia.

The reasons can be not only pathological but also quite natural. They do not require therapy, except in rare cases: pregnancy, menopause, adolescence, prolonged bed rest, lack of physical activity.(5)

References:

  1. Gibbons CH, Schmidt P, Biaggioni I, et al. The recommendations of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypertension. Journal of neurology. 2017;264(8):1567-1582.
  2. Espay AJ, LeWitt PA, Hauser RA, Merola A, Masellis M, Lang AE. Neurogenic orthostatic hypotension and supine hypertension in Parkinson’s disease and related synucleinopathies: prioritisation of treatment targets. The Lancet Neurology. 2016;15(9):954-966.
  3. Liguori I, Russo G, Coscia V, et al. Orthostatic hypotension in the elderly: a marker of clinical frailty? Journal of the American Medical Directors Association. 2018;19(9):779-785.
  4. McGrath R, McGrath R, Snih S, Markides K, Hall O, Peterson M. The Burden of Health Conditions for Aging Adults in the United States: Disability-Adjusted Life Years. Journal of the American Medical Directors Association. 2019;20(3):B33.
  5. Freeman R, Abuzinadah AR, Gibbons C, Jones P, Miglis MG, Sinn DI. Orthostatic hypotension: JACC state-of-the-art review. Journal of the American College of Cardiology. 2018;72(11):1294-1309.

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