Orthostatic hypotension associated with an epidermoid tumor of the IV ventricle

Abstract

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.

Cortical Morphology in Patients with Orthostatic Intolerance

“…Our present study also revealed cortical thinning in the orbitofrontal, post-central, and inferior temporal cortexes, which are areas known to be associated with the regulation of the autonomic nervous systems, and these findings consistently supported the susceptibility to OH in patients with OH [13,14,15]. Second, some case reports of OH showed an association with structural lesions, such as medullary cavernous angioma or epidermoid tumors of the fourth ventricle [4,5]. The authors of these studies insisted that these structural lesions interrupting the ANS resulted in OH.…”

“…Several cases have reported that structural abnormalities in the brain may induce OI because specific brain regions modulate the cardiovascular autonomic nervous system (ANS) [4,5]. Moreover, previous studies have demonstrated a volume reduction of the brain in patients with OI [6,7,8].…”

“…Some evidence suggests that brain abnormalities are associated with OI [4,5,6,7,8]. Several cases have reported that structural abnormalities in the brain may induce OI because specific brain regions modulate the cardiovascular autonomic nervous system (ANS) [4,5].…”

Cisto Epidermoide do IV Ventrículo. Relato de caso e revisão da literatura

“…Conforme o tamanho e evolução podem apresentar disfagia e diplopia por envolvimento de nervos cranianos 17 . Gomez et al 12 relataram um caso de CE no IV ventrículo associado a hipotensão ortostática.…”

“…Podem ser visíveis septos internos ou pode haver zonas hiperdensas devido ao conteúdo proteico. Ocasionalmente o conteúdo cístico pode ser hiperdenso, simulando uma hemorragia 12 . Após injeção de contraste pode ter um reforço fino na periferia da lesão, provavelmente devido a inflamação perilesional ou transformação maligna 24 .…”