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

作者：Martin Gallego A^*; Andrade Andrade I; Dawid Milner M S; Dominguez Paez M; Romero Moreno L; Gonzalez Garcia L; Carrasco Brenes A; Segura Fernandez Nogueras M; Ros Lopez B; Arraez Sanchez M A

来源：Autonomic Neuroscience-Basic & Clinical, 2016, 194: 52-57.

DOI：10.1016/j.autneu.2015.12.002

• Autonomic nervous system
• Dysautonomia
• Medulla oblongata
• Brainstem
• Nucleus of the solitary tract
• Pediatric
• Fourth ventricle

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.

• 出版日期2016-1