Midodrine treatment in the management of severe orthostatic hypotension after hemangioblastoma surgery.

摘要

Neurogenic orthostatic hypotension (OH) is frequently a major concern in patients with upper spinal cord injury but, although rare and scarcely reported, it can also pose a serious clinical problem after brainstem tumour surgery. In cases of spinal cord injury, the cardiovascular changes observed are the result of severe dysfunction of the sympathetic nervous system activity produced because of loss of supraspinal control of the autonomic system, further complicated in a sequential order by reduced overall sympathetic activity, morphological changes in sympathetic preganglionic neurons, end peripheral alpha-adrenoceptor hyperresponsiveness . All these events have been extensively studied in clinical and laboratory series of spinal cord injury fcut are still not completely understood. Neurogenic OH due to brainstem processes is even more difficult to explain because different nuclear damage can coexist with the loss of supraspinal control of the sympathetic nervous system, thus making treatment decisions challenging. We present an illustrative case of a patient who presented with a severe OH syndrome after surgical treatment of a bulbomedullary hemangioblastoma.