Department of Neurology, Radboud University Medical Centre, Nijmegen, the Netherlands | [b]
Department of Neurology, Rijnstate hospital, Arnhem, the Netherlands | [c]
Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands | [d]
Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
Correspondence to: Joery P. Molenaar, MD Radboud University Medical Centre Department of Neurology (HP 935) PO Box 9101, 6500 HB Nijmegen The Netherlands. Tel.: +31 24 3615202 (secretary); Fax: +31 24 3541122; E-mail: email@example.com.
Abstract: We present a 75-year-old woman with dementia and parkinsonism who developed severe orthostatic hypotension and eventually died. Autopsy revealed extensive Lewy body formation in the midbrain, limbic system, intermediate spinal cord, and medulla oblongata. Furthermore, a vast amount of Lewy bodies was seen in the paravertebral sympathetic ganglia which likely explained the severe autonomic failure. We speculate that this autonomic failure caused sudden death through dysregulation of respiration or heart rhythm, reminiscent of sudden death in multiple system atrophy (MSA). Clinicians should be aware of this complication in patients presenting with parkinsonism and autonomic dysfunction, and that sudden death may occur in dementia with Lewy bodies (DLB) as it does in MSA.
Keywords:  Dementia with Lewy bodies,  autonomic diseases,  multiple system atrophy, sudden death