Postural Hypotension in a Patient with Spinal Canal Stenosis

Abstract

Shahid Farooq

This case involves an elderly patient with a history of prostate cancer who was admitted to the hospital with a lower respiratory tract infection. Following recovery, he experienced recurrent falls due to a postural drop. Despite regular treatment and hydration, including fludrocortisone, the falls persisted. Various investigations, such as CT head, CT chest, abdomen and pelvis, transthoracic echocardiogram, HbA1c, renin-angiotensin ratio, cortisol, synacthen test, and carotid Doppler, were inconclusive and no apparent cause for the postural drop was found. However, an MRI of the entire spine revealed the presence of spinal stenosis and cauda equina without any accompanying symptoms of spinal disease. This discovery led to the diagnosis of autonomic neuropathy as the underlying cause of the patient's postural drop. The case highlights the importance of considering autonomic neuropathy in prostate cancer patients who experi- ence postural drops, even in the absence of obvious spinal disease symptoms.

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