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Advanced Neurology

CASE SERIES
Autonomic storms and autonomic movement

disorder associated with postural orthostatic
tachycardia syndrome misdiagnosed as

functional neurological disorder

Alyssa Khoo * , Jacob Brik 1 , and Anna D. Hohler 1,2
1
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

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
*Corresponding author:
Alyssa Khoo the visible presentation of POTS-related myoclonic episodes. Our study highlights
(ayk9839@nyu.edu) the challenges of distinguishing POTS from other conditions due to overlapping,
Citation: Khoo A, Brik J, Hohler AD. non-specific symptoms. In addition, this case series emphasizes the importance
Autonomic storms and autonomic of a thorough clinical assessment, including an orthostatic assessment and tilt
movement disorder associated with table testing, to ensure an accurate diagnosis. Misdiagnosis can delay appropriate
postural orthostatic tachycardia
syndrome misdiagnosed as management of POTS, highlighting the need for heightened awareness among
functional neurological disorder. clinicians when evaluating autonomic symptoms.
Adv Neurol. 2025;4(2):123-127.
doi: 10.36922/an.7653
Keywords: Postural orthostatic tachycardia syndrome; Functional neurological disorder;
Received: December 16, 2024
Autonomic storms; Myoclonus; Misdiagnosis; Clinical video
Revised: January 11, 2025
Accepted: February 11, 2025
Published online: March 7, 2025 1. Introduction
Copyright: © 2025 Author(s).
This is an Open-Access article Patients diagnosed with postural orthostatic tachycardia syndrome (POTS) typically
distributed under the terms of the have complex medical histories. POTS, a syndrome that presents with rapid heart
Creative Commons Attribution rate on standing, can be spurred by several factors, including, but not limited to,
License, permitting distribution,
1,2
and reproduction in any medium, stress, viral infection, trauma, pregnancy, and immunization. Autonomic storms
provided the original work is associated with POTS typically present with a constellation of symptoms including,
properly cited. but not limited to, alterations in levels of consciousness, increased posturing, dystonia,
Publisher’s Note: AccScience hypertension, hyperthermia, tachycardia, tachypnea, diaphoresis, agitation, tremor, and
Publishing remains neutral with myoclonus. More commonly seen after traumatic brain injuries, these storms may be
regard to jurisdictional claims in 3,4
published maps and institutional difficult to diagnose, especially in ambulatory care settings. In the US, POTS affects
5
affiliations. up to 3,000,000 people, which represent approximately 1% of the nation’s population.

Volume 4 Issue 2 (2025) 123 doi: 10.36922/an.7653