• Acute
• GBS
• DANGEROUS! Watch out
  
• Chronic
• Diabetes
• Parkinsonism (multi-system atrophy)
• Shy-Drager syndrome

• CVS
• Postural dizziness
  
• GI
• Upper - Vomiting
• Lower - Nocturnal diarrhoea
  
• Sweating
• Gustatory, in response to tyramines
  
• GUS
• Erectile dysfunction (early sign)
• Trouble voiding

Examination

• Pulse
• < 20 BPM change after 6 deep breaths
• < 15 BPM change after standing
• BP
• > 15/10 mmHg postural drop
• But wait 3 MINS before measuring
• Keep arm at heart level
  
• ECG RR ratio
  
• Changes after valsava (breathe into manometer + maintain 40 mmHg pressure)
  

Postural hypotension management

• Conservative
• Sit on bed for 3 mins before standing
• Fluids (3 L per day)
• Salt
• Stockings
• Sleep head-up
• Physical countermeasures
• Buttock tensing
• Stand on toes
• Tense arms and shoulders
• Medication
• Fludrocortisone
• But keep an eye on [Na]
• Alpha agonist
• Midodrine
• Erythropoietin

• Cerebellar
• Wide-based
• Drunken
• With slurred speech
• Stroke
• Circumduction
• Spastic paraparesis
• Stiff knees
• Parkinsons
• Shuffling
• Fenestrating (accelerating)
  
• Foot slap (common peroneal palsy)