Repeated hypotensive episodes with fluctuating symptoms in a patient with acute pontomedullary infarction.
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.
Kawano
Hiroyuki
H
Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, Suita, Japan. hkawanoo@gmail.com
Matsuoka
Hideki
H
Toyoda
Kazunori
K
Suzuki
Rieko
R
Kamide
Kei
K
Minematsu
Kazuo
K
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*