Neurological Assessment and Management of Autonomic Failure

This comprehensive review details the neurological assessment and management of autonomic failure, focusing specifically on neurogenic orthostatic hypotension (nOH). The text explains that this condition arises when nervous system damage prevents the body from maintaining stable blood pressure upon standing, often due to neurodegenerative synucleinopathies like Parkinson disease or multiple system atrophy. To diagnose these disorders, clinicians utilize orthostatic vital signs, specialized laboratory screenings, and advanced neuroimaging to differentiate between primary autonomic failures and other causes. Treatment strategies prioritize improving quality of life rather than achieving perfect blood pressure readings, starting with non-pharmacological interventions like increased salt intake and compression garments. For persistent symptoms, the sources outline various FDA-approved and off-label medications, such as midodrine and droxidopa, tailored to the patient’s specific pathophysiological profile. Ultimately, the review serves as a clinical guide for identifying the underlying triggers of fainting and dizziness while managing the complex balance of standing and supine blood pressure.