Neurogenic orthostatic hypotension is a highly prevalent and disabling feature of autonomic failure due to both peripheral and central neurodegenerative diseases. Community-based epidemiological studies have demonstrated a high morbidity and mortality associated with neurogenic orthostatic hypotension. It is due to impairment of baroreflex-mediated vasoconstriction of the skeletal muscle and splanchnic circulation and is caused by damage or dysfunction at central and/or peripheral sites in the baroreflex efferent pathway. Nonpharmacological and pharmacological interventions may be implemented to ameliorate the symptoms of orthostatic intolerance and improve quality of life. Many patients will be adequately treated by education, counseling, removal of hypotensive medications, and other nonpharmacological interventions, whereas more severely afflicted patients require pharmacological interventions. The first stage of pharmacological treatment involves repletion of central blood volume. If unsuccessful, this should be followed by treatment with sympathomimetic agents.

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Failure to recognize symptoms of orthostatic hypotension (OH) may result in falls, syncope, and injuries. The relationship between orthostatic changes in blood pressure and symptom occurrence and severity is not known. The goal of the present study was to define the relationship between the occurrence and severity of the symptoms of orthostatic hypotension (OH) and (1) the upright systolic blood pressure (SBP) and (2) the fall in SBP after tilting in patients with OH. We prospectively studied 89 patients with OH. Reported BP values include the lowest BP in the first 3 minutes of tilt and the change in blood pressure during tilt. Subjects were queried about symptoms of orthostatic intolerance while supine and during the first 3 minutes of tilt testing using Question 1 of the Orthostatic Hypotension Questionnaire. Mean tilted SBP was 101.6±26.1 mm Hg and mean SBP fall 47.9±18.1 mm Hg. Mean symptom scores when upright were: light-headedness (2.3/10±2.7), dizziness (1.6/10±2.5), and impending blackout (0.8/10±1.9). The majority of patients were asymptomatic or mildly symptomatic and no discrete cutoff for symptoms was observed. The magnitude of the SBP fall ( r =−0.07, P =NS) and the lowest upright SBP ( r =0.08, P =NS) did not correlate with any reported symptom. These results suggest a poor relationship between the magnitude of the orthostatic BP fall, the upright orthostatic BP, and symptoms. Many patients are asymptomatic despite substantial SBP falls and low orthostatic blood pressures. These findings have implications for clinical care of patients with OH and clinical trials to treat patients with OH.

Our results showed that the risk of stroke recurrence or death or the risk of stroke recurrence alone was comparable between the medical and endovascular therapy groups. A small preventive effect of endovascular therapy may exist, particularly if the 30 day postprocedural risk is reduced.

Introduction We translated the myasthenia gravis (MG)‐specific activities of daily living (MG‐ADL) scale into Arabic (MG‐ADL‐A) and assessed its psychometric properties. Methods We assessed reliability using Cronbach's α, reproducibility using the intraclass correlation coefficient, and validity using Spearman's correlations with MG composite (MGC) score, MG‐specific manual muscle test (MG‐MMT), and MG quality‐of‐life revised Arabic version (MGQOL15R‐A). Differences in MG‐ADL‐A scores among patients with different disease severity were evaluated by using the Kruskal–Wallis test. Sensitivity to change was examined by using the Wilcoxon signed‐rank test. Results We recruited 87 patients. The mean MG‐ADL‐A score was 3.38 ± 3.38 (α = 0.77, ICC = 0.99). The correlation coefficients between the MG‐ADL‐A and MGQOL15R‐A, MGC, and MG‐MMT were 0.63, 0.74, and 0.61, respectively (P < 0.001). The MG‐ADL‐A discriminated between different severity groups and was responsive to clinical improvement at follow‐up. Discussion The MG‐ADL‐A has rigorous psychometric properties and can be used with Arabic‐speaking patients with MG. Muscle Nerve 59:583–583, 2019