A case of relapsing multiple sclerosis presenting with only autonomic symptoms including orthostatic hypotension, hiccups and vomiting

Hiroshi Kuba, Kenji Arakawa, Takayuki Taniwaki, Yoshihisa Maeda, Takeshi Yamada, Jun-Ichi Kira

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4 Citations (Scopus)

Abstract

A 49-year-old woman, with a two-year-history of multiple screlosis (MS), noticed postural dizziness, intractable hiccups and vomiting. On admission, she had mild quadriparesis, hypesthesia below the C5 level, and a girdle sensation at the T5 and L 1 levels. A CSF examination showed slight increases in the protein level (48 mg/dl) and cell count (7/mm 3). Brain MRI demonstrated no obvious lesion in the medulla oblongata. The head-up-tilting test showed a decrease in the blood pressure from 105/63 mmHg to 70/55 mmHg. The pulse rate, however, increased from 57/min to 72/min. The cold pressure test also revealed a mild impairement in her blood pressure response. The R-R interval variation (coefficient of variation: CV(RR)) during normal breathing was 2.58 (normal: > 1.66). The valsalva ratio was 1.84 (normal: 1.4-2.0). The Aschner eye-ball presssure test, the blood pressure response to the injection of epinephrine, and the sweating response to the injection of acetylcholine were all normal. She was thus administered domperidone and chlorpromazine. Only domperidone effectively improved the nausea and vomiting. All symptoms, including orthostatic hypotension, hiccups and vomiting, disappeared about one month after admission. The remission of her symptoms was considered to reflect the natural course of MS. The results of autonomic nervous system function tests and her clinical features suggest that an irritable lesion in the medullary tegmentum, including the nucleus tractus solitarii, most likely caused her symptoms. The above findings indicate that autonomic symptoms, such as orthstatic hypotension, hiccups and vomiting, may sometimes be the only symptoms observed in a relapse of MS.

Original languageEnglish
Pages (from-to)930-934
Number of pages5
JournalClinical Neurology
Volume39
Issue number9
Publication statusPublished - Sep 1 1999

All Science Journal Classification (ASJC) codes

  • Clinical Neurology

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