[Hypertensive recurrent intracerebral hemorrhage accompanied with orthostatic hypotension and labile hypertension].

Authors reported a case of recurrent intracerebral hemorrhage accompanied by severe orthostatic hypotension. A 51-year-old women had recurrent intracerebral hemorrhage 3 times during a period of 2 years. The first and third hemorrhages were located in the right putaminal region, and the second hemorrhage in the left thalamic region. Cerebral angiography revealed neither evidence of vascular malformation nor that of tumor vessels. At the third admission, she became unconscious for three hours after admission, and emergent fronto-temporal craniotomy was performed. Light microscopic histological investigation with congo-red stain demonstrated the absence of cerebral amyloid angiopathy. Laboratory examination revealed no hemorrhagic diathesis. During hospitalization, She complained of dizziness in the standing position. When systolic blood pressure fell from 140 mmHg in the supine position to less than 80 mmHg in the standing position, she became unconscious. Her blood pressure was very labile with orthostatic changes and her systolic blood pressure was also very labile without orthostatic changes, changing from 108 mmHg to 218 mmHg. Severe orthostatic hypotension and labile hypertension made the medical control of hypertension difficult. In conclusion, both severe orthostatic hypotension and labile hypertension were risk factors of recurrence of intracerebral hemorrhage.