Orthostatic hypotension caused by a localised dorsal medullary tumour.

Yamashita, Américo Massafuni; Hirayama, Masaaki; Koike, Yasuhiro; Nukata, M; Hashizume, Masayuki; Takahashi, Anielle Cristhine de Medeiros

doi:10.1136/jnnp.61.1.118-a

Cited by 13 publications

(5 citation statements)

References 7 publications

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“…These findings indicate the presence of postganglionic type cardiovascular dysfunction, and a central type of dysfunction is reported to occur in MSA 56 These results seem to be relevant to the pathological lesions reported in MSA,17 27 28 which include the medullary cardiovascular centre (the solitary tract nucleus, the area reticularis superficialis ventrolateralis, the arcuate nucleus, and the dorsal vagal motor nuclei),29 30intermediolateral cell columns of the thoracic cord, sympathetic ganglia31 and postganglionic adrenergic fibres 32…”

Section: Discussionmentioning

confidence: 63%

Urinary dysfunction and orthostatic hypotension in multiple system atrophy: which is the more common and earlier manifestation?

Sakakibara

Hattori²,

Uchiyama³

et al. 2000

Journal of Neurology, Neurosurgery &Amp; Psychiatry

141

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Objectives-Urinary dysfunction and orthostatic hypotension are the prominent autonomic features in multiple system atrophy (MSA). A detailed questionnaire was given and autonomic function tests were performed in 121 patients with MSA concerning both urinary and cardiovascular systems. Methods-Replies to the questionnaire on autonomic symptoms were obtained from 121 patients including three clinical variants; olivopontocerebellar atrophy (OPCA) type in 48, striatonigral degeneration (SND) type in 17, and Shy-Drager type in 56. Urodynamic studies comprised measurement of postmicturition residuals, EMG cystometry, and bethanechol injection. Cardiovascular tests included head up tilt test, measurement of supine plasma noradrenaline (norepinephrine,NA), measurement of R-R variability (CV R-R), and intravenous infusions of NA and isoproterenol. Results-Urinary symptoms (96%) were found to be more common than orthostatic symptoms (43%) (p<0.01) in patients with MSA, particularly with OPCA (p<0.01) and SND (p<0.01) types. In 53 patients with both urinary and orthostatic symptoms, patients who had urinary symptoms first (48%) were more common than those who had orthostatic symptoms first (29%), and there were patients who developed both symptoms simultaneously (23%). Post-micturition residuals were noted in 74% of the patients. EMG cystometry showed detrusor hyperreflexia in 56%, low compliance in 31%, atonic curve in 5%, detrusor-sphincter dyssynergia in 45%, and neurogenic sphincter EMG in 74%. The cystometric curve tended to change from hyperreflexia to low compliance, then atonic curve in repeated tests. Bethanechol injection showed denervation supersensitivity of the bladder in 19%. Cardiovascular tests showed orthostatic hypotension below -30 mm Hg in 41%, low CV R-R below 1.5 in 57%, supine plasma NA below 100 pg/ml in 28%, and denervation supersensitivity of the vessels ( in 73%; 2 in 60%) and of the heart ( 1 in 62%). Conclusion-It is likely that urinary dysfunction is more common and often an earlier manifestation than orthostatic hypotension in patients with MSA, although subclinical cardiovascular abnormalities appear in the early stage of the disease. The responsible sites seem to be central and peripheral for both dysfunctions. (J Neurol Neurosurg Psychiatry 2000;68:65-69) Keywords: autonomic dysfunction; multiple system atrophy; orthostatic hypotension; urinary incontinence; urodynamic study Multiple system atrophy (MSA)c is known to have urinary disturbance.1 2 Some male patients with MSA have undergone urological surgery for prostatic hypertrophy before the correct diagnosis had been made. The results of the surgery are often transient or unfavourable because of the progressive nature of this disease. Previously we investigated urinary function in 86 patients with MSA considering three clinical variants; striatonigral degeneration (SND), sporadic olivopontocerebellar atrophy (OPCA), and the Shy-Drager syndrome. 3 The study showed that 4% of the patients with OPCA type, 16% with SND type, and 5...

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Section: Discussionmentioning

confidence: 63%

Urinary dysfunction and orthostatic hypotension in multiple system atrophy: which is the more common and earlier manifestation?

Sakakibara

Hattori²,

Uchiyama³

et al. 2000

Journal of Neurology, Neurosurgery &Amp; Psychiatry

141

View full text Add to dashboard Cite

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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: 79%

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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“…Several case reports [5][6][7][8][9][10][11][12][13][14] and a review 15 have described that disruption of the NS and its efferent fibers can cause baroreceptor failure. Overall, the reports show a poor clinical outcome, with death in 5 out of 14 cases, and varying effect of compressive garments, volume expansions, mineralocorticoids, and sympathomimetics.…”

Section: Discussionmentioning

confidence: 99%

Orthostatic hypotension after cervicomedullary junction surgery: illustrative case

Jacobsen

Schou

Poulsen

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUND Surgery at the cervicomedullary junction carries a risk of damaging vital brainstem functions. Because the nucleus of the solitary tract (NS) is involved in the baroreceptor reflex, damage to its integrity may lead to orthostatic hypotension. OBSERVATIONS A 56-year-old man with a medical history of hypertension, von Hippel-Lindau disease, and previous bilateral adrenalectomy due to pheochromocytoma was referred with symptoms of dysphagia and paralysis of the left vocal cord. Paralysis of the left vagus nerve was suspected. Magnetic resonance imaging revealed a contrast-enhancing cystic process in the cervicomedullary junction. Twenty-three years earlier, the patient had undergone surgical treatment for a hemangioblastoma in the same region. After repeated surgery, the patient temporarily developed orthostatic hypotension. At discharge, the patient no longer needed antihypertensive medication. LESSONS Surgery near the cervicomedullary junction can affect the NS, leading to disruption of the baroreceptor response that regulates blood pressure.

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Orthostatic hypotension caused by a localised dorsal medullary tumour.

Cited by 13 publications

References 7 publications

Urinary dysfunction and orthostatic hypotension in multiple system atrophy: which is the more common and earlier manifestation?

Urinary dysfunction and orthostatic hypotension in multiple system atrophy: which is the more common and earlier manifestation?

Orthostatic hypotension associated with an epidermoid tumor of the IV ventricle

Orthostatic hypotension after cervicomedullary junction surgery: illustrative case

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