Orthostatic hypotension-induced autonomic dysreflexia.

Three patients with chronic traumatic cervical myelopathy had severe orthostatic hyperhidrosis. Orthostatic challenge revealed that hypotension preceded hyperhidrosis, hypertension, and chills, all manifestations of autonomic dysreflexia. Treatment of orthostatic hypotension with fludrocortisone acetate relieved these symptoms. Therefore, orthostatic hypotension may trigger autonomic dysreflexia and the usual way of managing such patients, propping them upright, may be counterproductive.