Unmasking Postural Hypotension: A Stroke Mimic in an Elderly Patient

Postural hypotension (also known as orthostatic hypotension) is a common but often underrecognized condition, particularly prevalent among the elderly. Despite its frequency, its clinical significance is sometimes underestimated in routine clinical practice. Failure to recognize this condition can lead to repeated hospitalizations, unnecessary treatments, and increased healthcare costs. We report the case of a 79-year-old male who presented to us with multiple stroke-like episodes in the past six months. He underwent multiple CT scans of the brain/neck and MRI head scans. However, these investigations did not reveal any acute ischemic or hemorrhagic changes or any other acute intracranial abnormality. A simple and non-invasive lying/standing blood pressure measurement done in this admission managed to uncover the mystery of stroke mimic. This case illustrates the value of taking into account postural hypotension in the differential diagnosis of transient neurological symptoms.