Recurrent Syncope Due to Orthostatic Hypotension Following Lateral Medullary Infarction: A Case Report.

Lateral medullary infarction typically presents with sensory disturbance, cerebellar ataxia, and Horner's syndrome, whereas orthostatic hypotension is not generally considered a typical manifestation, but it may cause syncope. A 77-year-old man developed recurrent syncope during early mobilization following an acute right lateral medullary infarction. Head-up tilt testing demonstrated severe orthostatic hypotension with minimal heart rate response and inadequate plasma norepinephrine increase. Sequential treatment with midodrine, fludrocortisone, and droxidopa resolved the symptoms. Serial head-up tilt testing suggested a partial improvement in the orthostatic hemodynamic responses. Orthostatic hypotension should be considered in patients with lateral medullary infarction and positional symptoms, and serial head-up tilt testing may help document any changes in the orthostatic hemodynamic response.