Dysautonomia secondary to third ventriculostomy successfully managed with midodrine

Torcato Moreira Marques, André Almeida, Joana Pinheiro, Paula Oliveira Nascimento

Research output: Contribution to journalArticlepeer-review


Hypothalamic lesions can compromise its essential regulatory roles resulting in critical disruption of temperature and blood pressure homoeostasis. We present the case of a 55-year-old woman who had been previously submitted to several neurosurgical procedures aimed at treating idiopathic hydrocephalus. She presented to our department with recurring episodes of hypothermia and wide blood pressure variations, which had been worsening over the last few years. After extensive complementary workup, which excluded new neurological lesions or endocrinological conditions, hypothalamic dysfunction was assumed to be the cause of this syndrome. She was successfully treated with midodrine and on-demand captopril, which resulted in adequate control of her blood pressure. This case highlights the rare and unpredictable consequences of damage to the hypothalamus, depicting the favourable result of a heretofore unpublished medical approach.

Original languageEnglish
Article numbere232767
JournalBMJ case reports
Issue number6
Publication statusPublished - 17 Jun 2020


  • drugs: CNS (not psychiatric)
  • neuroendocrinology
  • neurological injury
  • neurology (drugs and medicines)
  • neurosurgery


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