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

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.