Recurrent Syncope Due to Orthostatic Hypotension Following Lateral Medullary Infarction: A Case Report
Abstract
Lateral medullary infarction typically presents with sensory disturbance, cerebellar ataxia, and Horner's syndrome, whereas orthostatic hypotension is not generally considered a typical manifestation, but it may cause syncope. A 77-year-old man developed recurrent syncope during early mobilization following an acute right lateral medullary infarction. Head-up tilt testing demonstrated severe orthostatic hypotension with minimal heart rate response and inadequate plasma norepinephrine increase. Sequential treatment with midodrine, fludrocortisone, and droxidopa resolved the symptoms. Serial head-up tilt testing suggested a partial improvement in the orthostatic hemodynamic responses. Orthostatic hypotension should be considered in patients with lateral medullary infarction and positional symptoms, and serial head-up tilt testing may help document any changes in the orthostatic hemodynamic response.
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BibTeX
@article{matsuo2026recurrent,
title = {{Recurrent Syncope Due to Orthostatic Hypotension Following Lateral Medullary Infarction: A Case Report}},
author = {Junichi Matsuo and Yasuyuki Hara and Keiichi Nakahara and Mitsuharu Ueda},
journal = {Internal Medicine},
year = {2026},
month = aug,
doi = {10.2169/internalmedicine.7325-26},
url = {https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_7325-26/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Recurrent Syncope Due to Orthostatic Hypotension Following Lateral Medullary Infarction: A Case Report
AU - Junichi Matsuo
AU - Yasuyuki Hara
AU - Keiichi Nakahara
AU - Mitsuharu Ueda
PY - 2026
DA - 2026/08/25
JO - Internal Medicine
DO - 10.2169/internalmedicine.7325-26
UR - https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_7325-26/_article
AB - Lateral medullary infarction typically presents with sensory disturbance, cerebellar ataxia, and Horner's syndrome, whereas orthostatic hypotension is not generally considered a typical manifestation, but it may cause syncope. A 77-year-old man developed recurrent syncope during early mobilization following an acute right lateral medullary infarction. Head-up tilt testing demonstrated severe orthostatic hypotension with minimal heart rate response and inadequate plasma norepinephrine increase. Sequential treatment with midodrine, fludrocortisone, and droxidopa resolved the symptoms. Serial head-up tilt testing suggested a partial improvement in the orthostatic hemodynamic responses. Orthostatic hypotension should be considered in patients with lateral medullary infarction and positional symptoms, and serial head-up tilt testing may help document any changes in the orthostatic hemodynamic response.
SN - 1349-7235
SN - 0918-2918
ER -