Severe orthostatic hypotension after removal of a medullary tumor: Cognitive strategies and tilt table used with blood pressure biofeedback

A 30-year old steel worker developed sleep apnea and severe orthostatic hypotension following surgery for a hemangioblastoma on the floor of the 4th ventricle. The hypotension, relatively unresponsive to hypertension-inducing medication for 14 months, was the main limiting factor for an active rehabilitation program. The suitability of a learning approach was indicated by the lesser involvement of the efferent arc compared to the afferent arc of the vasopressor response. Biofeeback using the Schneider cuff and a tilt-table increased voluntary control over blood pressure to the point where, from being wheelchair-bound, the patient became able to walk. His best within session increase of blood pressure was 54 mm Hg systolic pressure and 38 mm Hg diastolic pressure, in the 14th session (78/62 to 132/100).