[Transient severe orthostatic hypotension and hematoma of the pontine tegmentum]

A 57-year old patient presented with a posterior pontine hematoma and severe postural hypotension. The lesions were localized in the pontine tegmentum. They were bilateral and involved the area of the nucleus reticularis pontis caudalis, left medial lemniscus and roots of several cranial nerves, especially the VIth. The patient had lasting postural hypotension, with reduction of the physiological tachycardia. Investigation of heart rate regulation during manoeuvres however revealed that the accelerating reaction partially persisted, especially with Valsalva manoeuvre. Heart rate recording for 24 hours showed that the physiological nocturnal slowing down reaction had disappeared. In the following months, progressive but limited recovery of blood pressure regulation and accelerating reactions was observed.