Background: Metoclopramide is an antiemetic drug used frequently both in general practice and hos... more Background: Metoclopramide is an antiemetic drug used frequently both in general practice and hospitals. The drug has few side effects, mainly drowsiness, and can be used both in pregnancy and breastfeeding. Acute dystonia is a rare side effect mostly affecting children and young adults within 1-3 days after start of the medication. Women are more frequently affected than men. Material and methods: We present a clinical description of two patients admitted to our department with acute dystonia precipitated by metoclopramide. Results: Both patients received treatment with biperiden; one received additional benzodiazepine. Both recovered rapidly and were discharged symptom free the next day. Interpretation: Metoclopramide-induced dystonia is frightening both for the patient and the family. Because of concomitant anxiety and psychiatric symptoms, individuals are often regarded as hysterical. The attack can be abbreviated by parenteral administration of anticholinergic drugs. It is important that all doctors prescribing metoclopramide know of this side effect, especially when their patients are young females.
Journal of Neurology, Neurosurgery, and Psychiatry, Aug 12, 2022
Post-coronavirus disease 19 (COVID-19) syndrome has substantial health and economic implications.... more Post-coronavirus disease 19 (COVID-19) syndrome has substantial health and economic implications. It is multi-systemic, with prevalent autonomic symptoms. Understanding presentations and potential autonomic causes may help guide treatment strategies and recovery.All patients with a suspected or confirmed history of COVID-19 infection who underwent autonomic testing between May 2020 and October 2021 were reviewed retrospectively.We evaluated 62 patients (20 male, 42 female, mean age of 41.38 ±11.52). COVID-19 was PCR confirmed in 15 patients (26%), and five (8%) required acute hospital intervention. Most common symptoms included palpitations (81%), light-headedness/dizziness (62%), dyspnoea (48%), fatigue (46%), or cognitive symptoms(33%)Autonomic testing showed normal blood pressure responses to pressor stimuli, a mean respiratory sinus arrhythmia of 18.89b/m, and Valsalva ratio of 2.09. Postural tachycardia syndrome (PoTS) was diagnosed in 12 patients, autonomically mediated syncope (AMS) in 11, neurogenic orthostatic hypotension (NOH) in two, and initial orthostatic hypotension (IOH) in seven.Normal supine and upright plasma noradrenaline levels were measured in 34 patients (mean 283.38 pg/ml supine; 472.43pg/ml tilted).Autonomic testing was reassuring (PoTS and syncope) in the majority with abnormal testing (n=32, or 52%). Further phenotyping of PoTS to exclude neuropathic pathology may be needed. IOH and OH are important considerations.
Journal of Neurology, Neurosurgery & Psychiatry
Ross syndrome is a rare syndrome of segmental autonomic dysfunction, characterised by a triad of ... more Ross syndrome is a rare syndrome of segmental autonomic dysfunction, characterised by a triad of tonic pupils, hyporeflexia and anhidrosis. We present an atypical case of such a patient, presenting with added features of cardiovascular autonomic dysfunction.Our case concerns a 66-year-old female, who experienced progressive stepwise deterioration in the functionality of her autonomic nervous system. Her symptoms began with a left Adie’s pupil, followed by a chronic dry cough and diarrhoea. The onset of anhidrosis and orthostatic hypotension subsequently occurred 30 and 40 years later, respectively.Autonomic function testing confirmed cardiovascular autonomic failure as well as deficiencies of sudomotor, salivary and tear function. Severe orthostatic hypotension was demonstrated along with an abnormal Valsalva response, and loss of the nocturnal circadian rhythm. Thermoregulatory and dynamic sweat testing further confirmed global anhidrosis.Our case highlights that patients do not al...
Journal of Neurology, Neurosurgery & Psychiatry
IntroductionOrthostatic hypotension (OH) and supine hypertension (SH) are prevalent in alpha-synu... more IntroductionOrthostatic hypotension (OH) and supine hypertension (SH) are prevalent in alpha-synucle- inopathies, posing a therapeutic dilemma as OH treatment may worsen SH. We aimed to characterise SH in pure autonomic failure (PAF), multiple system atrophy (MSA), and Lewy body disorders (LBD: Parkinson’s disease and Dementia with Lewy bodies).Methods166 patients (72 PAF, 59 MSA, 35 LBD) underwent cardiovascular autonomic testing and 24hr- ambulatory blood pressure monitoring (24hr-ABPM). Demographic, clinical features, medications and cardiovascular autonomic biomarkers were compared.ResultsSH was present in more than half of patients with PAF, MSA and LBD (56%, 51% and 50%, respec- tively) without anti-hypotensive medications. Supine pre-stand BP during 24hr-ABPM detected SH with 60% sensitivity and 86% specificity [area under the curve 0.73 (95%CI 0.66-0.81)]. Supine noradrenaline levels were significantly higher in MSA vs PAF and LBD (268 vs 183 and 210 pg/ml, p<0.01). There...
Background: Metoclopramide is an antiemetic drug used frequently both in general practice and hos... more Background: Metoclopramide is an antiemetic drug used frequently both in general practice and hospitals. The drug has few side effects, mainly drowsiness, and can be used both in pregnancy and breastfeeding. Acute dystonia is a rare side effect mostly affecting children and young adults within 1-3 days after start of the medication. Women are more frequently affected than men. Material and methods: We present a clinical description of two patients admitted to our department with acute dystonia precipitated by metoclopramide. Results: Both patients received treatment with biperiden; one received additional benzodiazepine. Both recovered rapidly and were discharged symptom free the next day. Interpretation: Metoclopramide-induced dystonia is frightening both for the patient and the family. Because of concomitant anxiety and psychiatric symptoms, individuals are often regarded as hysterical. The attack can be abbreviated by parenteral administration of anticholinergic drugs. It is important that all doctors prescribing metoclopramide know of this side effect, especially when their patients are young females.
Journal of Neurology, Neurosurgery, and Psychiatry, Aug 12, 2022
Post-coronavirus disease 19 (COVID-19) syndrome has substantial health and economic implications.... more Post-coronavirus disease 19 (COVID-19) syndrome has substantial health and economic implications. It is multi-systemic, with prevalent autonomic symptoms. Understanding presentations and potential autonomic causes may help guide treatment strategies and recovery.All patients with a suspected or confirmed history of COVID-19 infection who underwent autonomic testing between May 2020 and October 2021 were reviewed retrospectively.We evaluated 62 patients (20 male, 42 female, mean age of 41.38 ±11.52). COVID-19 was PCR confirmed in 15 patients (26%), and five (8%) required acute hospital intervention. Most common symptoms included palpitations (81%), light-headedness/dizziness (62%), dyspnoea (48%), fatigue (46%), or cognitive symptoms(33%)Autonomic testing showed normal blood pressure responses to pressor stimuli, a mean respiratory sinus arrhythmia of 18.89b/m, and Valsalva ratio of 2.09. Postural tachycardia syndrome (PoTS) was diagnosed in 12 patients, autonomically mediated syncope (AMS) in 11, neurogenic orthostatic hypotension (NOH) in two, and initial orthostatic hypotension (IOH) in seven.Normal supine and upright plasma noradrenaline levels were measured in 34 patients (mean 283.38 pg/ml supine; 472.43pg/ml tilted).Autonomic testing was reassuring (PoTS and syncope) in the majority with abnormal testing (n=32, or 52%). Further phenotyping of PoTS to exclude neuropathic pathology may be needed. IOH and OH are important considerations.
Journal of Neurology, Neurosurgery & Psychiatry
Ross syndrome is a rare syndrome of segmental autonomic dysfunction, characterised by a triad of ... more Ross syndrome is a rare syndrome of segmental autonomic dysfunction, characterised by a triad of tonic pupils, hyporeflexia and anhidrosis. We present an atypical case of such a patient, presenting with added features of cardiovascular autonomic dysfunction.Our case concerns a 66-year-old female, who experienced progressive stepwise deterioration in the functionality of her autonomic nervous system. Her symptoms began with a left Adie’s pupil, followed by a chronic dry cough and diarrhoea. The onset of anhidrosis and orthostatic hypotension subsequently occurred 30 and 40 years later, respectively.Autonomic function testing confirmed cardiovascular autonomic failure as well as deficiencies of sudomotor, salivary and tear function. Severe orthostatic hypotension was demonstrated along with an abnormal Valsalva response, and loss of the nocturnal circadian rhythm. Thermoregulatory and dynamic sweat testing further confirmed global anhidrosis.Our case highlights that patients do not al...
Journal of Neurology, Neurosurgery & Psychiatry
IntroductionOrthostatic hypotension (OH) and supine hypertension (SH) are prevalent in alpha-synu... more IntroductionOrthostatic hypotension (OH) and supine hypertension (SH) are prevalent in alpha-synucle- inopathies, posing a therapeutic dilemma as OH treatment may worsen SH. We aimed to characterise SH in pure autonomic failure (PAF), multiple system atrophy (MSA), and Lewy body disorders (LBD: Parkinson’s disease and Dementia with Lewy bodies).Methods166 patients (72 PAF, 59 MSA, 35 LBD) underwent cardiovascular autonomic testing and 24hr- ambulatory blood pressure monitoring (24hr-ABPM). Demographic, clinical features, medications and cardiovascular autonomic biomarkers were compared.ResultsSH was present in more than half of patients with PAF, MSA and LBD (56%, 51% and 50%, respec- tively) without anti-hypotensive medications. Supine pre-stand BP during 24hr-ABPM detected SH with 60% sensitivity and 86% specificity [area under the curve 0.73 (95%CI 0.66-0.81)]. Supine noradrenaline levels were significantly higher in MSA vs PAF and LBD (268 vs 183 and 210 pg/ml, p<0.01). There...
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Papers by Ellen Merete Hagen