• Sara Hocker, Jason M Hoover, Ross C Puffer, and Fredric B Meyer.
• Division of Critical Care Neurology, Mayo Clinic, Mayo W8-B, 200 First Street SW, Rochester, MN 55905. USA. hocker.sara@mayo.edu
• Neurocrit Care. 2012 Apr 1;16(2):306-10.

BackgroundOrthostatic hypotension (OH) is an uncommon, but not rare manifestation of dorsal medullary lesions which has less commonly been described as arising de novo or significantly worsening following surgical resection of the lesion.MethodsWe present a case and review the English literature regarding dorsal medullary lesions and post-operative OH, focusing on the population of patients who develop new or significantly worsened OH after surgery with the hope that this information can be used to counsel patients.ResultsA 34-year old hypertensive woman was diagnosed with Von Hippel-Lindau syndrome during evaluation for headache. Magnetic resonance imaging of the brain and cervical spine revealed three posterior fossa hemangioblastomas and a resultant cervical syrinx. She was taken to surgery for resection of two of the posterior fossa hemangioblastomas, one of which was adherent to the obex. Post-operatively, the patient had significant OH requiring treatment. At the three month post-operative assessment, she was off all blood pressure medications.ConclusionsOH is an uncommon manifestation of dorsal medullary lesions and can rarely show significant worsening in severity following surgical resection of the lesion. Medical management in conjunction with physical rehabilitation may potentially result in recovery.

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