medulla_oblongata_injury [Neurosurgery Wiki]

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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 [[palpitation]]s and [[sweat]]ing 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. Martín-Gallego et al. postulate that a bilateral injury to both nuclei of the [[solitary tract]] may have caused central dysautonomia
((Martín-Gallego A, Andrade-Andrade I, Dawid-Milner MS, Domínguez-Páez M,
Romero-Moreno L, González-García L, Carrasco-Brenes A, Segura-Fernández-Nogueras 
M, Ros-López B, Arráez-Sánchez MA. Autonomic dysfunction elicited by a medulla
oblongata injury after fourth ventricle tumor surgery in a pediatric patient.
Auton Neurosci. 2015 Dec 4. pii: S1566-0702(15)30034-5. doi:
10.1016/j.autneu.2015.12.002. [Epub ahead of print] PubMed PMID: 26681574.))