Intramedullary anaplastic astrocytoma: a rare cause of orthostatic hypotension

History and physical examination: A 39-year-old women was admitted for eval uation of dizziness and hypotension. During standing the blood pressure dro pped from 130/80 to 80/40 mm-Hg. Ten weeks before admission she had recurre nt cerebral convulsions. Neurological evaluation showed a slight left hemip aresis. Computed tomography of the brain revealed a 1,5 +/- 1 cm cyst in th e left tempral region. It was thought that the cause of the recurrent convu lsions was alcohol abuse. During the next few weeks orthostatic hypotension increased and she was not able to work. Investigations: At admission abnormal findings included hypotension, horizo ntal nystagmus, and deviation of the soft palate to the right. After the pa tient was brought to an upright position during standardized passive tilt t esting she showed a defect in the sympathetic limb of the baroreceptor refl ex are. Head magnetic resonance tomography showed a signal-enhancing tumour in the cervicomedullary region. Treatment and clinical course: Before a planned biopsy could be performed t he patient died of respiratory arrest. Postmortem examination revealed an a naplastic grade III astrocytoma extending form the pens to the medulla oblo ngata. Conclusion: Upright tilting leads to pooling of blood in the legs. One of t he normal compensatory responses is a reflex tachycardia which our patient did not show as a sign of an afferent defect. Patients with orthostatic hyp otension as a prominent symptom should be investigated with a standardized tilt test. In special patients, additional neurological investigations are necessary.