Paroxysmal staring and masticatory automatisms during postural hypotension in a patient with multiple system atrophy.
OBJECTIVE
We studied a 51-year-old man with multiple system atrophy and autonomic insufficiency. He had repeated episodes of loss of contact, staring, and masticatory automatisms.


METHODS
Blood pressure during these events documented a systolic pressure of 60 mm Hg. Cardiovascular reflex tests provided evidence of autonomic failure. Head computed tomography (CT) revealed moderate, diffuse cortical and cerebellar atrophy.


RESULTS
These events were strictly related to blood pressure decreases and could be reproduced consistently by having the patient sit up after a meal. Ictal polygraphic recordings showed EEG changes consistent with anoxia, preceded by sudden hypotension with fixed heart rate.


CONCLUSIONS
Cerebral anoxia during a syncopal attack may therefore precipitate transient, sudden neurologic dysfunction that closely mimics complex partial seizures. Masticatory automatisms may represent a release phenomenon resulting from inactivation of neocortical structures by cerebral anoxia or reticular disconnection.
Iani
C
C
Clinica Neurologica, Ospedale S. Eugenio, Università di Roma Tor Vergata, Rome, Italy.
Attanasio
A
A
Manfredi
M
M
D001332:Automatism / Q000209:etiology*; D001342:Autonomic Nervous System Diseases / Q000150:complications / Q000175:diagnosis / Q000209:etiology; D002545:Brain Ischemia / Q000209:etiology; D002493:Central Nervous System Diseases / Q000150:complications* / Q000175:diagnosis; D003937:Diagnosis, Differential; D004569:Electroencephalography; D017029:Epilepsy, Complex Partial / Q000175:diagnosis / Q000209:etiology*; D005403:Fixation, Ocular; D006801:Humans; D007024:Hypotension, Orthostatic / Q000209:etiology*; D008297:Male; D008409:Mastication; D008875:Middle Aged