Orthostatic hypotension associated with an epidermoid tumor of the IV ventricle.
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.
Juan Carlos
JC
Gómez-Esteban
Koldo
K
Berganzo
Beatriz
B
Tijero
Joseba
J
Barcena
Juan J
JJ
Zarranz
D000328:Adult; D017776:Autonomic Pathways / Q000503:physiopathology; D017704:Baroreflex / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D001933:Brain Stem / Q000503:physiopathology; D002294:Carcinoma, Squamous Cell / Q000150:complications* / Q000473:pathology / Q000601:surgery; D002551:Cerebral Ventricle Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery; D020546:Fourth Ventricle / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D006849:Hydrocephalus / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000150:complications / Q000473:pathology / Q000601:surgery; D009460:Neurologic Examination; D019635:Neurosurgical Procedures; D012791:Shy-Drager Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt; D014696:Ventriculostomy