PMC5282596_01
123MIBG SCAN, DAT-SCAN, AND PLASMA CATECHOLAMINE LEVELS. a)
123MIBG scan demonstrated widespread cardiac sympathetic denervation;
b) DAT-SCAN showed abnormal radioligand binding affecting the
left putamen; c) catecholamine plasma concentrations showed low
norepinephrine levels in both supine and standing positions
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F1
BP monitoring; significant BP drop in the lying-to-standing test (53/28 mmHg at 3 minutes; normal < 20/10 mmHg [systolic/diastolic]); decreased heart rate variability (HRV) as measured by deep breathing test (Expiratory/Inspiratory ratio= 1.01; normal >= 1.1), lying-to-standing test (30:15 ratio= 1.0; normal >= 1.04), and Valsalva maneuver (Valsalva Ratio= 1.04; normal >= 1.14); and markedly low catecholamine plasma levels in both supine and orthostatic positions (Figure 1). Brain magnetic resonance imaging, peripheral nerve conduction studies (bilateral evaluation of peroneal, tibial, ulnar, median, and sural nerves distal latencies, amplitudes, motor and/or sensory nerve conduction velocities), vestibular tests, carotid/vertebral Doppler ultrasonography and neurological examination were normal. A 123Metaiodobezilguanidyne (123MIBG) cardiac positron emission tomography demonstrated widespread sympathetic denervation (Figure 1).