Letters4 December 2001Sympathetic Neurocirculatory Failure in Parkinson Disease: Evidence for an Etiologic Role of α-SynucleinDavid S. Goldstein, MD, PhD, Sheng-Ting Li, MD, and Irwin J. Kopin, MDDavid S. Goldstein, MD, PhDNational Institute of Neurological Disorders and Stroke; Bethesda, MD 20892-1620Search for more papers by this author, Sheng-Ting Li, MDNational Institute of Neurological Disorders and Stroke; Bethesda, MD 20892-1620Search for more papers by this author, and Irwin J. Kopin, MDNational Institute of Neurological Disorders and Stroke; Bethesda, MD 20892-1620Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-135-11-200112040-00026 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:In Parkinson disease, orthostatic hypotension reflects sympathetic neurocirculatory failure, characterized by cardiac sympathetic denervation (1). An Italian-American family has been shown to carry a mutation of the α-synuclein gene, with autosomal dominant transmission of Parkinson disease (2). We report neurogenic orthostatic hypotension and cardiac sympathetic denervation in an affected family member. Physical examination showed pill-roll tremor, bradykinesia, and cogwheel rigidity that improved with L-dopa–carbidopa. The patient had reproducible orthostatic hypotension without tachycardia. Speech and gait were approximately normal. Beat-to-beat blood pressure responses to the Valsalva maneuver indicated sympathetic neurocirculatory failure (3). The concentration of norepinephrine in antecubital ...