title: Autonomic dysfunction elicited by a medulla oblongata injury after fourth ventricle tumor surgery in a pediatric patient.
abstract: We report the case of a 9-year-old male patient with a recurrent fourth ventricle anaplastic ependymoma who developed severe arterial hypertension and blood pressure lability during and after surgery. A punctual bilateral lesion located within mid dorsal medulla oblongata caused by both infiltration and surgical resection was observed in postoperative MRI. Three years later, the patient remained neurologically stable but the family referred the presence of a chronic tachycardia as well as palpitations and sweating with flushing episodes related to environmental stress. On autonomic evaluation, an increase in sympathetic outflow with tachycardia together with orthostatic hypotension caused by baroreceptor reflex dysfunction was observed. We postulate that a bilateral injury to both nuclei of the solitary tract may have caused central dysautonomia.
authors.affiliation: Department of Neurosurgery, Regional University Hospital of Málaga, Málaga, Spain. Electronic address: alvaro1710@hotmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Martín-Gallego
authors.affiliation: Department of Autonomic Nervous System, CIMES, University of Málaga Foundation (FGUMA), Spain.
authors.forename: I
authors.initials: I
authors.lastname: Andrade-Andrade
authors.affiliation: Department of Autonomic Nervous System, CIMES, University of Málaga Foundation (FGUMA), Spain.
authors.forename: M S
authors.initials: MS
authors.lastname: Dawid-Milner
authors.affiliation: Department of Neurosurgery, Regional University Hospital of Málaga, Málaga, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Domínguez-Páez
authors.affiliation: Department of Neurosurgery, Regional University Hospital of Málaga, Málaga, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Romero-Moreno
authors.affiliation: Department of Neurosurgery, Regional University Hospital of Málaga, Málaga, Spain.
authors.forename: L
authors.initials: L
authors.lastname: González-García
authors.affiliation: Department of Neurosurgery, Regional University Hospital of Málaga, Málaga, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Carrasco-Brenes
authors.affiliation: Department of Neurosurgery, Regional University Hospital of Málaga, Málaga, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Segura-Fernández-Nogueras
authors.affiliation: Department of Neurosurgery, Regional University Hospital of Málaga, Málaga, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Ros-López
authors.affiliation: Department of Neurosurgery, Regional University Hospital of Málaga, Málaga, Spain.
authors.forename: M A
authors.initials: MA
authors.lastname: Arráez-Sánchez
mesh_terms: D001342:Autonomic Nervous System Diseases / Q000209:etiology*; D001794:Blood Pressure / Q000502:physiology; D001930:Brain Injuries / Q000209:etiology*; D002551:Cerebral Ventricle Neoplasms / Q000601:surgery; D002648:Child; D004806:Ependymoma / Q000601:surgery; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008526:Medulla Oblongata / Q000473:pathology*; D011183:Postoperative Complications / Q000503:physiopathology*
keywords: Autonomic nervous system; Brainstem; Dysautonomia; Fourth ventricle; Medulla oblongata; Nucleus of the solitary tract; Pediatric