기립저혈압을 동반한 뒤가쪽 연수경색

Dorsolateral Medullary Infarction Associated with Orthostatic Hypotension

기립저혈압은 연령이 높을수록 잘 생기며, 중추신경계와 말초신경계의 여러 원인에 의해 발생할 수 있다. 뇌줄기의 이상으로 인해 기립저혈압이 발생하나, 뇌경색으로 인한 경우는 드물다. 본 증례는 갑자기 발생한 뇌허혈 증상으로 내원하였고, 위치에 따른 어지럼증을 보여 기립저혈압으로 진단되었다. 뇌졸중 후 기립저혈압이 일시적으로 생길 수 있으며, 연수 부위가 기립저혈압 유발의 병소가 될 수 있다.

A 57-year-old male had sudden onset of vertigo, burning sensation of the right face, and right hemiparesis. His symptoms sustained for two hours. On admission, hemiparesis and burning sensation were disappeared. But, he complained of non-spinning dizziness that was aggravated by standing. Neurological examination revealed normal except ataxic gait. In tilt-table test, blood pressure was 129/65 mmHg in supine position and 105/60 mmHg in standing position after 3 minutes. Brain MRI showed a small acute right dorsolateral medullary infarction. He was treated with clopidogrel 75 mg per day. After 8 days, his postural dizziness had improved. Orthostatic hypotension is uncommon manifestation of acute dorsolateral medullary infarction.