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• Vol.46 No.5
• CLINICA NEUROL, 46: 332−334, 2006
• Vol.46 No.5 contents

Brief Clinical Note

A case of acute idiopathic autonomic neuropathy improved by intravenous immunoglobulin

Kimiko Yoshimaru, M.D., Yoshihiko Nakazato, M.D., Naotoshi Tamura, M.D., Toshimasa Yamamoto, M.D., Sayaka Naitou, M.D. and Kunio Shimazu, M.D.

Department of Neurology, Saitama Medical School

We describe a case of acute idiopathic autonomic neuropathy (AIAN) in which intravenous administration of immunoglobulin (IVIg) proved effective. A 32-year-old man was admitted with orthostatic dizziness. Fever and headache first developed 24 days earlier, and persisted for 10 days, when orthostatic dizziness developed and prevented him from walking. Hypohidrosis, constipation and impotence also developed. Neurological examinations revealed no abnormalities. Cerebrospinal fluid obtained showed pleocytosis (26/μl) and an increased level of protein (70 mg/dl). A head-up tilt test revealed that blood pressure decreased from 120/60 mmHg when supine to 60/40 mmHg in a head-up position, and the patient complained of dizziness. Plasma noradrenaline concentration was 26 pg/ml when supine and 44 pg/ml in a head-up position. Results of MIBG cardiac scintigraphy were normal. Dizziness disappeared after initiating IVIg (0.4 g/kg/day). A head-up tilt test was performed 7 days after IVIg, revealing blood pressures of 106/61 mmHg when supine and 103/71 mmHg in a head-up position. These results suggest that IVIg should be considered as a choice to treat early AIAN.

(CLINICA NEUROL, 46: 332−334, 2006)
key words: acute idiopathic autonomic neuropathy (AIAN), intravenous administration of immunoglobulin (IVIg), orthostatic hypotension, autonomic disorder

(Received: 18-Apr-05)