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Pure autonomic failure (PAF) is an idiopathic sporadic disorder characterized by orthostatic hypotension with evidence of more widespread autonomic failure. It has been suggested that PAF belongs to the group of synucleinopathies, as autopsy studies showed α-synuclein-positive Lewy bodies in sympathetic neurons of patients with PAF.1 REM sleep behavioral disorder (RBD) appears to be an almost universal feature of synucleinopathies. Whereas initial studies suggested that RBD specifically occurs in multiple system atrophy (MSA), subsequent studies showed that it is also a frequent feature of Parkinson disease (PD) and dementia with Lewy bodies (DLB).2 Furthermore, patients with isolated RBD often later develop PD.3
We here present a consecutive unselected series of three patients with PAF (M/F: 2/1, …
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