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Case report
Dysautonomia secondary to third ventriculostomy successfully managed with midodrine
  1. Torcato Moreira Marques1,
  2. André Almeida1,2,
  3. Joana Pinheiro3 and
  4. Paula Oliveira Nascimento1
  1. 1Internal Medicine Department, Hospital de Santa Marta, Lisboa, Portugal
  2. 2NOVA Medica School, Faculdade de Ciências Médicas da Universidade NOVA de Lisboa, Lisboa, Portugal
  3. 3Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal
  1. Correspondence to Dr Torcato Moreira Marques; torcato.marques{at}


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the rare and unpredictable consequences of damage to the hypothalamus, depicting the favourable result of a heretofore unpublished medical approach.

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

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  • Contributors TMM and JP assembled patient data and conceived the case report outline. AA and PON critically appraised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.