200 Section - Unmasking MSA-C: Orthostatic Hypotension Revealed by the Lean Test

Wednesday, May 20, 2026

6:00 PM - 7:30 PM PT

Corresponding Author/Autor a quien dirigir la corr(s)

WI

Weaam IBRAHEEM, n/a

Speciality Registrar in Rehabilitation Medicine
National Rehabilitation Center
Nottingham, England, United Kingdom

Co-Author/Coautor(s)

PS

Prina Singh, n/a

FOUNDATION YEAR DOCTOR
National Rehabilitation Center, NUH
Nottingham, England, United Kingdom

Presenting Author/Autor expositor(s)

JH

Javvad Haider, MD

Consultant in Physical and Rehabilitation Medicine
National Rehabilitation Center
Nottingham, England, United Kingdom

Co-Author/Coautor(s)

MS

Manoj Sivan, MD

Professor/Consultant in Physical and Rehabilitation Medicine
National Rehabilitation Center
Nottingham, England, United Kingdom

Case Diagnosis: Multiple system atrophy-cerebellar type with significant orthostatic hypotension

Case Description: A patient referred to neurorehabilitation clinic with dizziness, slurred speech, tremor, ataxic gait, and persistent fatigue.Prior investigations included MRI showing cerebellar atrophy, with negative paraneoplastic screen and genetic testing, the diagnosis at that point was cerebellar syndrome of unknown cause. During clinical assessment, a 10-minute Lean Test was performed due to the symptom pattern and revealed significant OH, indicating autonomic dysfunction that had previously not been recognised.This finding provided a crucial clue for the diagnosis of MSA-C and guided a structured rehabilitation plan including education, physical strategies, and stepwise treatment. At follow-up, the patient showed symptomatic improvement and was able to manage her daily symptoms once the underlying OH was addressed.

Discussions: The Lean Test originally developed by NASA to assess cardiovascular responses in astronauts, it has been adapted for clinical use in detecting orthostatic intolerance. Its simplicity, reproducibility, and non‑invasive nature make it a valuable tool in routine practice.The LEAN test provides an efficient means of detecting dysautonomia syndromes at early stages where early symptoms such as fatigue, dizziness, urinary dysfunction, gastrointestinal disturbances and cognitive clouding precede overt functional decline. These early indicators are particularly relevant across common rehabilitation populations, including individuals with joint hypermobility disorders, neurodegenerative diseases, and post-viral syndromes such as long COVID.In these conditions, dysautonomia frequently contributes to functional limitations, and often remains under-recognized without targeted assessment.The LEAN test allows physicians to identify subtle autonomic dysfunction at an early stage, improving diagnostic clarity and formulation of individualized rehabilitation planning.

Conclusions: This case highlights the diagnostic utility of the Lean Test in identifying neurogenic OH in MSA‑C. More broadly, lean test serves as a practical bedside tool for detecting diverse dysautonomia syndromes, underscoring the importance of simple clinical assessments in enhancing diagnostic confidence and improving patient care and rehabilitation planning.