小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 体位性轻度头晕、晕厥和其他脑灌注不足症状
其他诊断因素
- 帕金森症特征
- 小脑共济失调
- 体重减轻
- 静息心动过速或者心率变异受损
- 胃肠动力异常
- 勃起功能障碍和缺少射精
- 无汗症、畏热、皮肤干燥、局部多汗
- 尿频、尿急、遗尿
危险因素
- 老人
- 衰弱和机体“去适应
- 损害交感神经张力的药物
- 血容量缺失/贫血
- 自主神经功能紊乱（比如，糖尿病）
- 帕金森病
- 路易体痴呆
- 多系统萎缩症
诊断性检查
首要检查
- 姿势检查
需考虑的检查
- 倾斜试验
- 去甲肾上腺素
- 深呼吸
- 咽鼓管捏鼻鼓气法
- 神经传导检查和肌电图（EMG）
- 定量分析汗腺运动反射试验(QSART)
- 心律变异性
- 24 小时血压监测
- 自身免疫性抗体
- 胸部 CT
- 血清和尿液电泳
- 脂肪垫活检
- 基因检测
治疗流程
所有患者
撰稿人
作者
Italo Biaggioni, MD
Professor of Medicine and Pharmacology
Vanderbilt University
Nashville
TN
利益声明
IB is a consultant for Theravance Biopharma and has received grant support from NIH, Theravance Biopharma, and Biohaven. IB holds a patent for an automated binder for the treatment of orthostatic hypotension. IB is an author of a number of references cited in this topic.
Lucy Norcliffe-Kaufmann, PhD
Assistant Professor
Dysautonomia Center
Department of Physiology and Neuroscience
NYU Langone Medical Center
New York
NY
利益声明
LNK is a board member of the American Autonomic Society and has received grant support from Theravance Biopharma, PTC Therapeutics, National Institutes of Health, Michael J. Fox Foundation, and the Familial Dysautonomia Foundation. LNK is an author of a number of references cited in this topic.
Horacio Kaufmann, MD
Professor of Neurology
Medicine and Pediatrics
New York University School of Medicine
New York
NY
利益声明
HK is editor in chief of Clinical Autonomic Research and serves as principal investigator of a clinical trial sponsored by Biogen MA Inc. HK has received consultancy fees from Lilly USA LLC, Biohaven Pharmaceuticals Inc, Takeda Pharmaceutical Company Ltd, Ono Pharma UK Ltd, Lundbeck LLC, and Theravance Biopharma US Inc. HK is an author of a number of references cited in this topic.
同行评议者
Phillip A. Low, MD
Robert D. and Patricia E. Kern Professor of Neurology
Mayo Clinic College of Medicine
Rochester
MN
利益声明
PAL is an author of a reference cited in this topic.
William P. Cheshire, MD
Professor of Neurology
Mayo Clinic
Jacksonville
FL
利益声明
WPC declares that he has no competing interests.
Alan Moore, MB, FRCPI
Consultant Geriatrician
Beaumont Hospital
Dublin
Ireland
利益声明
AM has received payment from Shire Pharmaceuticals, manufacturer of midodrine, for providing educational talks, and the department in which he works has received unrestricted educational grants from Shire Pharmaceuticals.
鉴别诊断
- 神经介导性（血管迷走神经性）晕厥
- 眩晕
- 老年人非特异性跌倒
更多 鉴别诊断指南
- 晕厥的诊断和治疗指南
- 关于神经源性仰卧位高血压定义的共识声明
更多 指南
登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容
内容使用需遵循免责声明