第三心室切開術に伴う自律神経失調症はミドドリンで管理されている

Dysautonomia secondary to third ventriculostomy successfully managed with midodrine.

• Torcato Moreira Marques
• André Almeida
• Joana Pinheiro
• Paula Oliveira Nascimento

抄録

視床下部の病変は、体温と血圧の恒常性維持に重大な障害をもたらす視床下部の本質的な調節機能を損なう可能性がある。特発性水頭症の治療を目的とした脳神経外科手術を受けたことのある55歳女性の症例を紹介する。当科を受診した女性は，低体温症と広い血圧変動を繰り返し，ここ数年で悪化していた．広範囲にわたる補完的検査の結果，新たな神経学的病変や内分泌学的疾患は除外され，視床下部機能障害がこの症候群の原因であると推定された．彼女はミドドリンとオンデマンドカプトプリルによる治療を受け、血圧を十分にコントロールすることに成功した。この症例は、視床下部の損傷がもたらす稀で予測不可能な結果を浮き彫りにし、これまでに発表されていなかった医学的アプローチの好ましい結果を示している。

Hypothalamic lesions can compromise its essential regulatory roles resulting in critical disruption of temperature and blood pressure homoeostasis. We present the case of a 55-year-old woman who had been previously submitted to several neurosurgical procedures aimed at treating idiopathic hydrocephalus. She presented to our department with recurring episodes of hypothermia and wide blood pressure variations, which had been worsening over the last few years. After extensive complementary workup, which excluded new neurological lesions or endocrinological conditions, hypothalamic dysfunction was assumed to be the cause of this syndrome. She was successfully treated with midodrine and on-demand captopril, which resulted in adequate control of her blood pressure. This case highlights the rare and unpredictable consequences of damage to the hypothalamus, depicting the favourable result of a heretofore unpublished medical approach.

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