AccScience Publishing / AN / Online First / DOI: 10.36922/an.7653
CASE SERIES

Autonomic storms and autonomic movement disorder associated with postural orthostatic tachycardia syndrome misdiagnosed as functional neurological disorder

Alyssa Khoo1* Jacob Brik1 Anna D. Hohler1,2
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1 Department of Neurology, St. Elizabeth’s Medical Center, Brighton, Massachusetts, United States of America
2 Department of Neurology, Faculty of Neurology Education, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, United States of America
Advanced Neurology, 7653 https://doi.org/10.36922/an.7653
Submitted: 16 December 2024 | Revised: 11 January 2025 | Accepted: 11 February 2025 | Published: 7 March 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Abstract

Patients with postural orthostatic tachycardia syndrome (POTS) typically present with a constellation of symptoms, some of which may mimic other disorders and may lead to misdiagnosis, including autonomic storms and autonomic movement disorders. We discuss two cases in which patients with POTS were misdiagnosed as functional neurological disorder. In both cases, the patients were initially misdiagnosed on hospital admission and then referred to neurologists, who correctly diagnosed them with POTS. We also review video evidence of these patients’ storms to showcase the visible presentation of POTS-related myoclonic episodes. Our study highlights the challenges of distinguishing POTS from other conditions due to overlapping, non-specific symptoms. In addition, this case series emphasizes the importance of a thorough clinical assessment, including an orthostatic assessment and tilt table testing, to ensure an accurate diagnosis. Misdiagnosis can delay appropriate management of POTS, highlighting the need for heightened awareness among clinicians when evaluating autonomic symptoms.

Keywords
Postural orthostatic tachycardia syndrome
Functional neurological disorder
Autonomic storms
Myoclonus
Misdiagnosis
Clinical video
Funding
None.
Conflict of interest
The authors declare that they have no competing interests.
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Advanced Neurology, Electronic ISSN: 2810-9619 Print ISSN: 3060-8589, Published by AccScience Publishing