[Dysautonomia and behavioural disorders from periventricular metastasis (author's transl)]

In a patient presenting dysautonomia a severe orthostatic hypotension revealed the presence of a subependymal metastatic infiltration from a large cell anaplastic bronchial carcinoma. Clinical pharmacological studies were conducted. A paradoxical sinus bradycardia during orthostatism, and an absence of bradycardia after clonidine injection, were suggestive of a central origin of the dysautonomia. At post-mortem, metastatic infiltration involved the walls of the lateral ventricles, and the floor of the IIIrd and IVth ventricles, from where it invaded structures responsible for cardiovascular control. Correlations could be established between the results of the clinical pharmacological tests and the pathological findings. Also present were a) anterograde amnesia dating from the onset of the orthostatic hypotension, probably due to compression of the anterior pillars of the trigone by tumour invasion of the septum; b) behavioural disorders with absence of spontaneous movement and speech, indifference and docility, probably arising from destruction of the septum.