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Objective:A case of advanced nasopharyngeal carcinoma with autonomic dysfunction was reported and its pathophysiological mechanism was discussed.Methods:The diagnosis and treatment of a nasopharyngeal carcinoma patient with autonomic nervous dysfunction such as paroxysmal syncope was summarized, and the pathophysiological mechanism of this case was analyzed by searching related literature.Results:Nasopharyngeal carcinoma characterized by autonomic dysfunction was rare and had a poor prognosis. Autonomic dysfunction caused by nasopharyngeal carcinoma was associated with carotid sinus syndrome, parapharyngeal space syncope syndrome, glossopharyngeal nerve reflex and paraneoplastic neuropathy.Conclusions:Early detection and treatment is a key factor affecting the prognosis of nasopharyngeal carcinoma. Clinicians should consider nasopharyngeal carcinoma as one of the differential diagnoses in the diagnosis and treatment of patients with autonomic nervous dysfunction combined with cranial nerve damage.
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A 25-year-old women was admitted to the department of Neurology in Affiliated 2nd Hospital of Hainan Medical University due to recurrent syncope for 8 years and return for 2 months. She had multiple episodes of syncope at onset. She presented with the feeling of weakness in both lower limbs, and fatigue in the past year. She experienced pain in the waist and limbs joint in recent three months. Physical examination showed joint hyperactivity in metacarpophalangeal joints of both upper limbs, increased skin elasticity. Active-standing transcranial Doppler (TCD) test showed that the average heart rate (HR) and the average middle cerebral artery (MCA) blood flow velocity in the supine position were 79 beats/min and 62 cm/s, respectively; while the average HR and the average MCA blood flow velocity in the standing position were 126 beats/min, 47 cm/s. Meanwhile,the blood pressure was normal during the test of supine-to-standing TCD. Genetic testing indicated LDB3 transgenation. The patient was diagnosed as postural tachycardia syndrome (joint-hypermobility-related), Ehlers-Danlos syndrome, and relieved by fluid infusion and rehabilitation therapy.
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@#To explore the prevalence and related factors of orthostatic intolerance in patients with Type 2 diabetes. Methods Patients with Type 2 diabetes were enrolled，admitted to the Department of Neurology from September 2020 to October 2021.General clinical data were collected. The active standing TCD test were performed on all the patients，and the changes of blood pressure，heart rate and cerebral hemodynamics were recorded from supine to standing for 1 min，3 min，5 min and 10 min. Orthostatic intolerance questionnaire were completed. Association between Orthostatic intolerance questionnaire score and results of supine to standing TCD test were analyzed. Results A total of 161 patients were enrolled for this study，70 （43.5%） with Symptoms of orthostatic intolerance and 91 （56.5%） without. Correlation analysis showed that Orthostatic intolerance questionnaire score have positive correlation with the magnitude of systolic pressure fall，diastolic pressure fall，Cerebral blood flow velocity fall and cerebral blood flow response to tilt score.（r=0.57、P= 0.000，r=0.44、P=0.000，r=0.30、P=0.022，r=0.24、P=0.044）.Conclusion The proportion of OI in patients with Type 2 diabetes is high，which is associated with orthostatic blood pressure and cerebral blood flow decline.
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Weight loss is common in non-motor symptoms in Parkinson disease (PD).It may predate motor symptom onset,and may be associated with the development of disease.However,it was less accounted of clinically.The pathophysiology of weight loss in PD is very complicated.This review discusses the pathogenesis of PD weight loss from dopaminergic dysfunction,energy expenditure/intake imbalance,central mechanisms of feeding behavior regulation,and neuroendocrine abnormalities.