2019 Volume 47 Issue 2 Pages 71-73
Multiple system atrophy is a component of spinocerebellar degeneration. Multiple system atrophy is a progressive neurodegenerative disorder characterized by a combination of symptoms affecting both the autonomic nervous system and movement. Symptoms of autonomic failure that may be seen in patients with multiple system atrophy include fainting. We herein report a patient with multiple system atrophy who transiently lost consciousness as a result of postprandial hypotension while in the waiting room of general dentistry.
A 60-year-old man with multiple system atrophy complaining of dental pain and requiring oral care visited our dental clinic. While the patient was in the waiting room, a dental hygienist connected him to a monitor. His blood pressure then decreased to 41/31 mmHg. An emergency call was immediately placed, and the patient’s vital signs were examined. Although the electrocardiogram findings were normal, the patient transiently lost consciousness. His blood pressure was 43/34 mmHg, his heart rate was 95 beats/min, and his pulse oximetry level was 95%. His blood sugar level was 105 mg/dl. A bolus dose of 2 mg of ephedrine was administered intravenously, indirectly stimulating the sympathetic nervous system and causing the patient’s blood pressure to increase to 78/38 mmHg. Approximately 3 minutes later, the patient showed a slight reaction when his name was called.
The clinical findings strongly suggested postprandial hypotension. When performing dental treatments for patients with multiple system atrophy, caution regarding hypotension and severe autonomic nervous failure is needed. Additionally, preparation for emergency resuscitation is absolutely necessary.
