Ann Clin Neurophysiol.  2019 Jan;21(1):66-69. 10.14253/acn.2019.21.1.66.

Orthostatic hypotension with meningoencephalitis involving the rostral ventrolateral medulla

• Jung YI
• Sunwoo MK
• Lee HJ
• Seo JH
• Kim J

• KMID: 2434191
• DOI: http://doi.org/10.14253/acn.2019.21.1.66

Abstract

Orthostatic hypotension (OH) is commonly associated with autonomic failure in the peripheral nervous system. Less often it is related to central lesions in brainstem and cerebellum. We describe a patient with OH associated with tuberculosis meningoencephalitis involving the brainstem including rostral ventrolateral medulla. This is the first case of OH resulting from focal lesions in the dorsal medulla in a patient with meningoencephalitis.

Keyword

Orthostatic hypotension; Rostral ventrolateral medulla; Meningoencephalitis

MeSH Terms

Brain Stem
Cerebellum
Humans
Hypotension, Orthostatic*
Meningoencephalitis*
Peripheral Nervous System
Tuberculosis

Figure

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  Fig. 1 (A) Axial T2-weighted magnetic resonance imaging showing leptomeningeal enhancement without parenchymal changes. (B, C) Axial T2 and flair showing aggravated involvement of the medullary lesion, including the rostal ventrolateral medulla (RVLM) in follow-up magnetic resonance imaging.

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  Fig. 2 Autonomic function test showed the sympathetic failure. (A) Absence of sympathetic skin response. (B) Valsalva maneuver test showed a transient decrease during first few seconds by activation of baroreceptors, but not followed by compensatory tachycardia.

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