Central vasomotor failure in a patient with medulla arteriovenous fistula.
We report on the case of a 60-year-old man who suffered from hiccup, dysphagia and unsteady gait for three months. He was diagnosed with intracranial dural arteriovenous fistula in medulla with retrograde perimedullary vein drainage. He developed quadriplegia, persistent shock status and symptomatic bradycardia immediately after a conventional cerebral angiography study. After excluding cardiogenic, hypovolemic, anaphylactic and septic shock, central vasomotor failure caused by venous thrombosis of the lesion was considered. The patient's central vasomotor failure recovered after continuous dopamine infusion treatment for 42 days. We concluded that venous hypertension with venous thrombosis in rostral ventrolateral medulla (RVLM), a major vasomotor center in the brainstem, was the lesion site. In our case, vasomotor dysfunction caused by an RVLM lesion related to venous thrombosis is considered as causative.
Lin
Ching-Hwung
CH
Section of Neurology, Department of Medicine Kaohsiung Veterans General Hospital, Taiwan.
Lo
Yuk-Keung
YK
Lin
Yuh-Te
YT
Li
Jie-Yuan
JY
Lai
Ping-Hong
PH
Gau
Yung-Yen
YY
D001164:Arteriovenous Fistula / Q000150:complications*; D001919:Bradycardia / Q000209:etiology*; D006801:Humans; D008297:Male; D008526:Medulla Oblongata / Q000098:blood supply*; D008875:Middle Aged; D012769:Shock / Q000209:etiology*