title: Orthostatic hypotension following resection of a dorsal medullary hemangioblastoma.
abstract: BACKGROUND
  Orthostatic hypotension (OH) is an uncommon, but not rare manifestation of dorsal medullary lesions which has less commonly been described as arising de novo or significantly worsening following surgical resection of the lesion.
  
  
  METHODS
  We present a case and review the English literature regarding dorsal medullary lesions and post-operative OH, focusing on the population of patients who develop new or significantly worsened OH after surgery with the hope that this information can be used to counsel patients.
  
  
  RESULTS
  A 34-year old hypertensive woman was diagnosed with Von Hippel-Lindau syndrome during evaluation for headache. Magnetic resonance imaging of the brain and cervical spine revealed three posterior fossa hemangioblastomas and a resultant cervical syrinx. She was taken to surgery for resection of two of the posterior fossa hemangioblastomas, one of which was adherent to the obex. Post-operatively, the patient had significant OH requiring treatment. At the three month post-operative assessment, she was off all blood pressure medications.
  
  
  CONCLUSIONS
  OH is an uncommon manifestation of dorsal medullary lesions and can rarely show significant worsening in severity following surgical resection of the lesion. Medical management in conjunction with physical rehabilitation may potentially result in recovery.
authors.affiliation: Division of Critical Care Neurology, Mayo Clinic, Mayo W8-B, 200 First Street SW, Rochester, MN 55905. USA. hocker.sara@mayo.edu
authors.forename: Sara
authors.initials: S
authors.lastname: Hocker
authors.forename: Jason M
authors.initials: JM
authors.lastname: Hoover
authors.forename: Ross C
authors.initials: RC
authors.lastname: Puffer
authors.forename: Fredric B
authors.initials: FB
authors.lastname: Meyer
mesh_terms: D000328:Adult; D005260:Female; D018325:Hemangioblastoma / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007024:Hypotension, Orthostatic; D008279:Magnetic Resonance Imaging; D008526:Medulla Oblongata / Q000473:pathology / Q000601:surgery*; D019635:Neurosurgical Procedures; D011183:Postoperative Complications; D006623:von Hippel-Lindau Disease / Q000473:pathology / Q000601:surgery*