Repeated hypotensive episodes with fluctuating symptoms in a patient with acute pontomedullary infarction.

Dysfunction of cardiovascular regulation, including arterial hypotension, is a rare complication of acute ischemic stroke. We report a patient with an acute pontomedullary infarction who frequently had severe hypotensive episodes. A 78-year-old diabetic man suddenly developed faintness and left hemiparesis. MRI revealed a fresh infarct at the right pontomedullary region, including (or adjacent to) the rostral ventrolateral medulla. During the initial few weeks, urination and head-up tilts frequently induced hypotensive episodes accompanied by systolic blood pressure drops of up to 60 mmHg that were accompanied by fluctuating symptoms. In conclusion, pontomedullary stroke should be considered as a possible cause of hypotension accompanied by fluctuation of neurological symptoms during acute stroke.