Reversible orthostatic hypotension in PICA territory cerebellar infarction

Abstract

Impaired sympathetic vasoconstriction reflex of muscle and splanchnic vessels in response to orthostatic stress can cause orthostatic hypotension [1]. Orthostatic hypotension was reported in focal central nervous system lesions involving the brainstem or spinal cord [2,3]. The cerebellum has also been reported to participate in regulating blood pressure (BP) by modulation of vestibulo-sympathetic responses [4–7]. However, most of the studies [4–7] on the role of cerebellum in regulating BP were based on the results of an experimental animal model. The cardiovascular response during orthostasis after a cerebellar lesion remains uncertain in humans. Moreover, there are no reports on the influence of cerebellar infarction on cardiovascular control according to a positional change in humans. We examined a patient with a cerebellar infarction who had orthostatic dizziness after vertigo subsided and who also showed orthostatic hypotension during a head-up tilt test.