scholarly journals Conservative rehabilitation for a patient presenting with severe orthostatic hypotension after surgical management of brainstem tumor: illustrative case

2021 ◽  
Vol 1 (25) ◽  
Author(s):  
Misato Nagumo ◽  
Syoichi Tashiro ◽  
Nanako Hijikata ◽  
Aiko Ishikawa ◽  
Takenori Akiyama ◽  
...  
Keyword(s):  
Orthostatic Hypotension ◽  
Surgical Management ◽  
Pharmacological Therapy ◽  
Illustrative Case ◽  
Compression Stockings ◽  
Postoperative Rehabilitation ◽  
Basic Activity ◽  
Accompanying Symptoms ◽  
Prognostic Prediction ◽  
Rehabilitation Strategy

BACKGROUND Blood pressure (BP) dysregulation is frequently observed in patients after surgical management of brainstem lesions; however, there has been no standard rehabilitation. Considering the conflicting risks for hypoperfusion and disuse syndrome in these patients, a safe and effective rehabilitative strategy is warranted. OBSERVATIONS A 50-year-old man who had undergone craniotomy for resection of a recurrent dorsal medullary epidermoid cyst developed persistent orthostatic hypotension. It was resistant to physical exercise, pharmacological therapy, abdominal binders, and compression stockings; therefore, it inhibited postoperative rehabilitation. Although the responsible lesion was not clearly visible on the postoperative image, accompanying symptoms, including segmental sensory impairment, implied an improvement in BP control. Although there was a trade-off between the risk of developing disuse syndrome and a delay in functional recovery, the authors decided to continue a conservative rehabilitation strategy rather than increasing the workload. The patient’s BP control was gradually restored by the seventh postoperative week, and the authors proceeded with basic activity training. LESSONS A conservative prognostic prediction-based rehabilitation strategy was applied in this case. The precise evaluation of the accompanying neurological symptoms was helpful in deciding the treatment regimen. The conflicting risks for hypoperfusion and disuse syndrome in such cases must be considered.

scholarly journals The efficacy of nonpharmacologic intervention for orthostatic hypotension associated with aging

Neurology ◽  
2018 ◽  
Vol 91 (7) ◽  
pp. e652-e656 ◽  
Author(s):  
Julia L. Newton ◽  
James Frith
Keyword(s):  
Older People ◽  
Orthostatic Hypotension ◽  
Response Rate ◽  
Cardiovascular Responses ◽  
Class Iii ◽  
Abdominal Compression ◽  
Compression Stockings ◽  
Water Drinking ◽  
Nonpharmacologic Intervention

ObjectiveTo determine the efficacy and safety of nonpharmacologic interventions for orthostatic hypotension (OH) secondary to aging.MethodsA total of 150 orthostatic challenges were performed in 25 older people (age 60–92 years) to determine cardiovascular responses to bolus water drinking, compression stockings, abdominal compression, and physical countermaneuvers. Primary outcome was response rate as assessed by proportion of participants whose systolic blood pressure (SBP) drop improved by ≥10 mm Hg.ResultsThe response rate to bolus water drinking was 56% (95% confidence interval [CI] 36.7–74.2), with standing SBP increasing by 12 mm Hg (95% CI 4–20). Physical countermaneuvers were efficacious in 44% (95% CI 25.8–63.3) but had little effect on standing SBP (+7.5 mm Hg [95% CI −1 to 16]). Abdominal compression was efficacious in 52% (95% CI 32.9–70.7) and improved standing SBP (+10 mm Hg [95% CI 2–18]). Compression stockings were the least efficacious therapy (32% [95% CI 16.1–51.4]) and had little effect on standing SBP (+6 mm Hg [95% CI −1, 13]). No intervention improved symptoms during standing. There were no adverse events.ConclusionsBolus water drinking should become the standard first-line nonpharmacologic intervention, whereas compression stockings should be disregarded in this population.Classification of evidenceThis study provides Class III evidence that for older people with OH, bolus water drinking is superior to other nonpharmacologic interventions in decreasing SBP drop.

scholarly journals Surgical management of an enchondroma of the proximal phalanx of the foot: An illustrative case report

2020 ◽  
Vol 8 ◽  
pp. 2050313X2094589
Author(s):  
Steven R Edwards ◽  
Andrew C Kingsford
Keyword(s):  
Case Report ◽  
Bone Graft ◽  
Surgical Management ◽  
Proximal Phalanx ◽  
Illustrative Case ◽  
Optimal Management ◽  
Tibial Bone ◽  
Benign Tumours ◽  
Surrounding Bone

Enchondromas are benign tumours that may become symptomatic due to expansive pressure on the surrounding bone. In this case, a 27-year-old male developed a symptomatic enchondroma within the proximal phalanx of his left fourth toe. Resection and insertion of a bone graft were considered optimal management. Histopathology testing confirmed the diagnosis of an isolated enchondroma. The patient was monitored closely for 3 months postoperatively and reported full satisfaction at his 12-month review. Enchondroma resection and insertion of a tibial bone graft may provide an effective long-term solution for a symptomatic enchondroma of the toe.

Graded Compression Stockings Prevent Post-spaceflight Orthostatic Hypotension

2009 ◽  
Vol 41 ◽  
pp. 59-60
Author(s):  
Steven H. Platts ◽  
Angela K. Brown ◽  
James P. Locke ◽  
Michael B. Stenger
Keyword(s):  
Orthostatic Hypotension ◽  
Compression Stockings

Alternatives to Knee Braces

2021 ◽  
Author(s):  
John Milner ◽  
Davis Hartnettt ◽  
Steven F. DeFroda
Keyword(s):  
Current Evidence ◽  
Compression Stockings ◽  
Postoperative Rehabilitation ◽  
Over The Counter ◽  
Rehabilitation Period ◽  
Chronic Injuries ◽  
Knee Braces ◽  
Muscle Groups ◽  
Musculoskeletal Care ◽  
The Ideal

AbstractKnee braces continue to be a widely utilized piece of medical equipment, ranging from simple over the counter sleeves to more complex functional braces, with the ability to provide electrical stimulation to muscle groups. Despite their popularity, alternatives to knee braces exist for patients who find braces to be ineffective, uncomfortable, cumbersome, or overly expensive. While high-quality studies are lacking for modalities such as neoprene sleeves, compression stockings, and kinesiotaping, there is promising evidence that these interventions can confer an element of stability and pain relief for a variety of knee pathologies both with regard to acute and chronic injuries as well as in the postoperative rehabilitation period. While no “holy grail” exists for the ideal brace, or bracing alternative, it is important for providers to be aware of the options available to patients as well as the current evidence for these various modalities, so that the provider can best guide musculoskeletal care.

scholarly journals 39 * THERAPEUTIC USE OF COMPRESSION STOCKINGS FOR ORTHOSTATIC HYPOTENSION: AN ASSESSMENT OF PATIENT AND PHYSICIAN PERSPECTIVES AND PRACTICES

2014 ◽  
Vol 43 (suppl 2) ◽  
pp. ii9-ii10 ◽  
Author(s):  
C. Quinn ◽  
J. Cooke ◽  
B. Deegan ◽  
A. Hannigan ◽  
C. Dunne ◽  
...  
Keyword(s):  
Orthostatic Hypotension ◽  
Therapeutic Use ◽  
Compression Stockings ◽  
Physician Perspectives

scholarly journals Evaluation of Patients with Syncope in the Emergency Department: How to Adjust Pharmacological Therapy

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 603
Author(s):  
Martina Rafanelli ◽  
Giuseppe Dario Testa ◽  
Giulia Rivasi ◽  
Andrea Ungar
Keyword(s):  
Emergency Department ◽  
Orthostatic Hypotension ◽  
Hypotensive Effect ◽  
Pharmacological Therapy ◽  
Initial Assessment ◽  
Cardiovascular Risks ◽  
Drug Management ◽  
Drug Induced ◽  
Drug History ◽  
Psychoactive Medications

The rate of syncope in the Emergency Department ranges between 0.9 and 1.7%. Syncope is mostly related to a underlying reflex or orthostatic mechanism. A bradycardic or a hypotensive phenotype, may be identified. The latter is the most common and could be constitutional or drug induced. Consequently, obtaining an accurate drug history is an important step of the initial assessment of syncope. As anti-hypertensive medication might be responsible for orthostatic hypotension, managing hypertension in patients with syncope requires finding an ideal balance between hypotensive and cardiovascular risks. The choice of anti-hypertensive molecule as well as the therapeutic regimen and dosage, influences the risk of syncope. Not only could anti-hypertensive drugs have a hypotensive effect but opioids and psychoactive medications may also be involved in the mechanism of syncope. Proper drug management could reduce syncope recurrences and their consequences.

scholarly journals Therapeutic use of compression stockings for orthostatic hypotension: an assessment of patient and physician perspectives and practices

2014 ◽  
Vol 44 (2) ◽  
pp. 339-342 ◽  
Author(s):  
C. Quinn ◽  
B. Deegan ◽  
J. Cooke ◽  
S. Carew ◽  
A. Hannigan ◽  
...  
Keyword(s):  
Orthostatic Hypotension ◽  
Therapeutic Use ◽  
Compression Stockings ◽  
Physician Perspectives

scholarly journals Squamous Carcinoma of the Lung Presenting as Migraine-Type Headache: A Case Report

2015 ◽  
Vol 8 (1) ◽  
pp. 142-147
Author(s):  
Eswaran Waran
Keyword(s):  
Lung Cancer ◽  
Case Report ◽  
Orthostatic Hypotension ◽  
Squamous Cell ◽  
Cell Lung Cancer ◽  
Pharmacological Treatment ◽  
Squamous Carcinoma ◽  
Pharmacological Therapy ◽  
Reflex Tachycardia ◽  
Type Headache

Introduction: Orthostatic hypotension has long been recognised as a paraneoplastic effect of lung cancer. Lung cancer presenting with orthostatic hypotension and migraine-type headaches has not been previously described in the literature. Case Report: A 62-year-old Caucasian male presented with headaches, typical of his migraine, after a 30-year migraine-free period. An examination revealed a significant postural drop in BP with reflex tachycardia and no other features of dysautonomia. Investigations showed a metastatic squamous cell lung cancer. Pharmacological treatment of orthostatic hypotension resolved the migraine-type headaches. Discussion: Orthostatic hypotension is associated with lung cancer. Prompt pharmacological treatment in patients not responding to non-pharmacological therapy can provide relief from disabling symptoms of orthostatic hypotension. In this patient, this included symptoms consistent with migraine-type headaches.

scholarly journals Surgical management of thoracic myelopathy from long-segment epidural lipomatosis with skip hemilaminotomies: illustrative case

2021 ◽  
Vol 2 (24) ◽  
Keyword(s):  
Adipose Tissue ◽  
Surgical Treatment ◽  
Surgical Management ◽  
Spinal Deformity ◽  
Neurological Deficits ◽  
Illustrative Case ◽  
Medical Conditions ◽  
Thoracic Myelopathy ◽  
Epidural Lipomatosis ◽  
Thoracic Spinal

BACKGROUND Thoracic spinal epidural lipomatosis (SEL) involves the pathological overgrowth of histologically normal, unencapsulated adipose tissue that can compress the spinal cord and cause myelopathy. SEL has been associated with multiple medical conditions, including Scheuermann kyphosis (SK). Optimal treatment strategies for SEL, especially in the setting of a sagittal spinal deformity, remain unclear. OBSERVATIONS In this report, the authors discussed surgical management of a patient with thoracic SEL and SK using skip hemilaminotomies for resection of the epidural adipose tissue. To the authors’ knowledge, only one other report described a similar surgical technique in a patient who did not have a spinal deformity. LESSONS When conservative efforts fail, thoracic SEL may require surgical treatment. Surgical planning must account for co-medical conditions such as SK. The described approach involving skip laminotomies, which minimizes spine destabilization, is a viable option to treat SEL spanning multiple spinal segments. Prognosis after surgical treatment varies and is impacted by multiple factors, including severity of preoperative neurological deficits.

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