Midodrine treatment in the management of severe orthostatic hypotension after hemangioblastoma surgery

Jabary, N.; Sarabia, Rosario; Sánchez, Teresa Sánchez; Gordillo, R

doi:10.1007/s00701-006-1103-z

Cited by 9 publications

(7 citation statements)

References 19 publications

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“…Dysautonomia is rarely reported in focal brainstem lesions such as tumors [2,10,11,17,18], syringobulbia [9] and stroke [13]. In our patient it is likely that in addition to the focal medulla damage, an increase in pressure upon the floor of the fourth ventricle secondary to hydrocephalus played a role in the orthostatic hypotension, as it improved after shunting.…”

Section: Discussionmentioning

confidence: 64%

Orthostatic hypotension associated with an epidermoid tumor of the IV ventricle

et al. 2009

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We report the case of a 32-year-old man with an epidermoid tumor of the fourth ventricle. About 14 years later, he showed a tumor recurrence which was removed. After this procedure the patient complained of presyncopal and syncopal crisis while attempting to stand or walk. On examination, severe orthostatic hypotension was confirmed and autonomic tests were abnormal. The brain MRI showed a tetraventricular hydrocephalus predominating in the fourth ventricle. A ventriculo-peritoneal shunt was performed, and after surgery the orthostatic intolerance improved. We believe that hydrocephalus has probably been a contributory factor to orthostatic hypotension, and suggest expanding testing for dysautonomia in patients with hydrocephalus.

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Section: Discussionmentioning

confidence: 64%

Orthostatic hypotension associated with an epidermoid tumor of the IV ventricle

et al. 2009

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“…The most commonly reported side effects include piloerection, pruritus, mydriasis, palpitations, tachycardia, headaches, urinary retention and supine hypertension (4,8). None of the side effects was observed in our patients.…”

Section: Intruductionmentioning

confidence: 49%

“…Midodrine, the prodrug of desglymidodrine, is a peripheral, selective alpha-1 adrenergic receptor agonist that increases blood pressure via arterial and venous vasoconstriction. Usual doses of midodrine ranges from 2.5 to 10 mg two or three times a day (4,8,9). We used 5 mg/d and decreased to 2.5 mg/d in our patients.…”

Section: Intruductionmentioning

confidence: 99%

Midodrine Treatment of Orthostatic Hypotension in Patients With Acute Tetraplegia

...

2012

Tftr

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© Tur kish Jo ur nal of Physi cal Me di ci ne and Re ha bi li ta ti on, pub lis hed by Ga le nos Pub lis hing. / © Tür ki ye Fi zik sel Tıp ve Re ha bi li tas yon Der gi si, Ga le nos Ya yı ne vi ta ra fın dan ba sıl mış tır. IntruductionOrthostatic hypotension (OH) is one of the complications in patients with spinal cord injury (SCI) particularly in the acute stage. Impairment in the autonomic nervous system, usually in patients with cervical and high thoracic SCI, causes OH that is defined as decrease in systolic blood pressure of at least 20 mm Hg or diastolic blood pressure of at least 10 mm Hg upon changing body position from supine to upright posture. It results from an inefficient response to postural changes in blood pressure. OH may be symptomatic or asymptomatic. Symptoms of OH include dizziness, light-headedness, fainting, blurred vision, muscle weakness, fatigue, nausea, palpitations, and headache (1-4).Non-pharmacological interventions that have been used are salt and fluid regulation, pressure to the abdominal region, upper body exercise, functional electrical stimulation (FES) applied to the legs, compression bandages and/or pressure stockings and tilt training program (3,5). Pharmacological treatment includes agents acting on blood vessels, on blood volume or on other pressor mechanisms. The medications used are fludrocortisone, pyridostigmine, ergotamine, ephedrine, desmopressin, erythropoietin and midodrine (3,4,6).We experienced two cases of tetraplegia having OH treated with midodrine that did not respond to conventional nonpharmacological interventions. Both of the patients were women. One of them was 33-year-old with C4 tetraplegia AIS-A and the other was 19-year-old with C5 tetraplegia AIS-A. The subjects were in acute stage of SCI that were in the first 3 months postinjury. They continued to have OH during transfer to wheelchair or tilt table exercises despite use of antiembolic compression bandage, abdominal binder, and progressive exercises with tilt table. Five mg/d midodrine in two divided doses was started. Improvement in symptoms was observed in both of the patients after 20 days, thus, the dosage was decreased to 2.5 mg/d in two divided doses. One month later, patients' tolerated tilt angle was 90 degrees, so midodrine was stopped in both of the patients. Midodrine was not continued in one of the patients. In the other patient, midodrine 2.5 mg/d was started again one week later because OH continued occasionally. Autonomic dysreflexia (AD) was not observed. No side effects were observed.The predisposition to OH following SCI is not fully understood, but it is thought to be multifactorial (3). Following SCI, the low level of efferent sympathetic activity and the loss of reflex vasoconstriction are among the major causes of OH. OH is more common in tetraplegia than in paraplegia. OH persisting during the first month following SCI was reported to occur in 74% of cervical and in 20% of upper thoracic motor complete SCI patients (7). Both of our two patients had complete tetraplegia. We...

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“…While there are scattered reports of posterior fossa tumors causing this phenomenon, including hemangioblastoma [ 6 , 8 , 10 , 14 ], we present the first case of a patient with truly refractory OH in spite of maximal medical therapy, in whom surgical resection was not possible and neuroimaging revealed no progression in the size or associated medullary compression. Aggressive medical treatment with volume replacement and medications to augment her peripheral vascular resistance and intravascular volume were instrumental in restoring her ambulation.…”

Section: Discussionmentioning

confidence: 93%

Refractory Orthostatic Hypotension Caused by a Recurrent Hemangioblastoma: Case Report and Review of the Literature

Nangunoori¹,

Koduri²,

Singh³

et al. 2016

Cureus

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Refractory orthostatic hypotension (OH) has been described following surgery for posterior fossa tumors. We present the case of a patient with refractory OH following attempted surgical resection. We also reviewed the available literature to describe pathophysiologic mechanisms for this rare entity.A 58-year-old female was found to have a hemangioblastoma at the cervicomedullary junction following workup for dysphagia and coordination difficulties. She underwent successful suboccipital craniotomy and gross total resection. However, the patient’s symptoms returned several years later and a magnetic resonance imaging (MRI) showed tumor recurrence. A surgical resection was attempted but could not be performed due to significant scarring. Following discharge, she returned to our care with severe syncopal episodes, refractory OH, and an inability to ambulate. Aggressive medical therapy resulted in a gradual improvement in her ability to ambulate and a reduction in her orthostatic episodes. Unfortunately she died due to sepsis from aspiration pneumonia several months later. A survey of the literature yielded a total of 10 reports (14 patients) with refractory OH as a result of tumors in the cervicomedullary region. Five of fourteen patients died from complications related to OH and brainstem compression while the remainder had some improvement and were discharged.Refractory OH can rarely be a presenting sign of a tumor in the cervicomedullary junction or can manifest following surgical resection of tumors in this region. Recognition of OH and the institution of medical therapy (sodium and fluid replacement) and pharmacotherapy may curb the significant morbidity associated with this condition.

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Midodrine treatment in the management of severe orthostatic hypotension after hemangioblastoma surgery

Cited by 9 publications

References 19 publications

Orthostatic hypotension associated with an epidermoid tumor of the IV ventricle

Orthostatic hypotension associated with an epidermoid tumor of the IV ventricle

Midodrine Treatment of Orthostatic Hypotension in Patients With Acute Tetraplegia

Refractory Orthostatic Hypotension Caused by a Recurrent Hemangioblastoma: Case Report and Review of the Literature

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