Autonomic dysfunction elicited by a medulla oblongata injury after fourth ventricle tumor surgery in a pediatric patient

Martín-Gallego, Álvaro; Andrade-Andrade, I.; Dawid-Milner, Marc Stefan; Domínguez-Páez, Miguel; Romero-Moreno, Luisa M.; González-García, Laura; Carrasco-Brenes, Antonio; Segura-Fernández-Nogueras, M.; López, Bienvenido Ros; Arráez-Sánchez, Miguel Ángel

doi:10.1016/j.autneu.2015.12.002

Cited by 5 publications

(2 citation statements)

References 36 publications

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“…The rostral VLM (RVLM) is an important sympathetic nervous system in the regulation of BP that provides atonic retention to peripheral vessels. 12 It is known that the solitary nucleus inhibits the RVLM via the caudal VLM; therefore, the dysfunctional solitary nucleus facilitates RVLM activation, causing central hypertension. In our patient, who did not present with supine hypertension, OH was possibly caused by disturbance of not only the solitary nucleus but also the descending sympathoexcitatory pathways from the RVLM.…”

Section: Discussionmentioning

confidence: 99%

Conservative rehabilitation for a patient presenting with severe orthostatic hypotension after surgical management of brainstem tumor: illustrative case

Nagumo¹,

Tashiro

Hijikata³

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUND Blood pressure (BP) dysregulation is frequently observed in patients after surgical management of brainstem lesions; however, there has been no standard rehabilitation. Considering the conflicting risks for hypoperfusion and disuse syndrome in these patients, a safe and effective rehabilitative strategy is warranted. OBSERVATIONS A 50-year-old man who had undergone craniotomy for resection of a recurrent dorsal medullary epidermoid cyst developed persistent orthostatic hypotension. It was resistant to physical exercise, pharmacological therapy, abdominal binders, and compression stockings; therefore, it inhibited postoperative rehabilitation. Although the responsible lesion was not clearly visible on the postoperative image, accompanying symptoms, including segmental sensory impairment, implied an improvement in BP control. Although there was a trade-off between the risk of developing disuse syndrome and a delay in functional recovery, the authors decided to continue a conservative rehabilitation strategy rather than increasing the workload. The patient’s BP control was gradually restored by the seventh postoperative week, and the authors proceeded with basic activity training. LESSONS A conservative prognostic prediction-based rehabilitation strategy was applied in this case. The precise evaluation of the accompanying neurological symptoms was helpful in deciding the treatment regimen. The conflicting risks for hypoperfusion and disuse syndrome in such cases must be considered.

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Section: Discussionmentioning

confidence: 99%

Conservative rehabilitation for a patient presenting with severe orthostatic hypotension after surgical management of brainstem tumor: illustrative case

Nagumo¹,

Tashiro

Hijikata³

et al. 2021

Journal of Neurosurgery: Case Lessons

View full text Add to dashboard Cite

show abstract

“…These virus-induced changes can impact the components of the autonomic network leading to symptoms of dysautonomia. Possible targets that can lead to dysautonomia include autonomic centers like the hypothalamus and medulla oblongata in the brainstem ( Martin-Gallego et al, 2016 ; Nosaka, 1966 ) ( Fig. 1 ).…”

Section: Mechanisms Of Autonomic Dysfunction By Sars-cov-2mentioning

confidence: 99%