case_images: PMC11746903_01
case_images: Diagnostic workup with differential diagnosis of orthostatic hypotension.
case_images: fnins-18-1505727-g001.jpg
case_images: PMC11746903_01_fnins-18-1505727-g001.jpg
case_images: fig1
case_images: Neurological disorders affecting the nervous system or inner ear, as well as related infections, were ruled out (Figure 1). After three min, the reactional tachycardia could no longer maintain adequate cardiac output (shown in Supplementary Figure 1), accompanied by a continual drop in blood pressure. We eliminated most causes of orthostatic hypotension (Figure 1) and hypothesized that the orthostatic hypotension was caused by an immunological disorder, triggered by the SARS-CoV-2 infection (or, less likely, by its vaccine).
case_images: Beat-by-beat blood pressure and heart rate during first HUTT-pv performed on day 27 without stepping and before IVIG treatment (A), on day 27 with stepping (B), and three months after discharge without stepping (C) showing a completely physiological response (increase in DBP and HR, stable SBP).
case_images: fnins-18-1505727-g002.jpg
case_images: PMC11746903_01_fnins-18-1505727-g002.jpg
case_images: fig2
case_images: The patient performed the test wearing compressive stockings and without stepping (Figure 2, panel A). She only experienced mild orthostatic symptoms (Figure 2, panel B). During a new HUTT-pv (Figure 2, panel C), lasting 17 min in a passive standing position, she experienced mild orthostatic symptoms without a significant drop in blood pressure.
case_images: Cervical Doppler artery ultrasound in supine (green) and upright (orange) positions without stepping, three months after discharge after new orthostatic intolerance. (A) Cerebral Blood Flow; Blood flow (B), Diameter (C) and Velocity (D) in each artery comparing supine and upright (70 ) positions. ICA: Internal Carotid Artery.
case_images: fnins-18-1505727-g003.jpg
case_images: PMC11746903_01_fnins-18-1505727-g003.jpg
case_images: fig3
case_images: At the same time, a carotid artery Doppler ultrasound showed a 27% decrease in cerebral blood flow (CBF) when upright (Figure 3).