title: Repeated hypotensive episodes with fluctuating symptoms in a patient with acute pontomedullary infarction.
abstract: Dysfunction of cardiovascular regulation, including arterial hypotension, is a rare complication of acute ischemic stroke. We report a patient with an acute pontomedullary infarction who frequently had severe hypotensive episodes. A 78-year-old diabetic man suddenly developed faintness and left hemiparesis. MRI revealed a fresh infarct at the right pontomedullary region, including (or adjacent to) the rostral ventrolateral medulla. During the initial few weeks, urination and head-up tilts frequently induced hypotensive episodes accompanied by systolic blood pressure drops of up to 60 mmHg that were accompanied by fluctuating symptoms. In conclusion, pontomedullary stroke should be considered as a possible cause of hypotension accompanied by fluctuation of neurological symptoms during acute stroke.
authors.affiliation: Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, Suita, Japan. hkawanoo@gmail.com
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kawano
authors.forename: Hideki
authors.initials: H
authors.lastname: Matsuoka
authors.forename: Kazunori
authors.initials: K
authors.lastname: Toyoda
authors.forename: Rieko
authors.initials: R
authors.lastname: Suzuki
authors.forename: Kei
authors.initials: K
authors.lastname: Kamide
authors.forename: Kazuo
authors.initials: K
authors.lastname: Minematsu
mesh_terms: D000208:Acute Disease; D000368:Aged; D001794:Blood Pressure; D020526:Brain Stem Infarctions / Q000150:complications* / Q000473:pathology*; D006801:Humans; D007022:Hypotension / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008526:Medulla Oblongata / Q000473:pathology*; D011149:Pons / Q000473:pathology*