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An Unusual Case of Asystole Occurring during Deep Brain Stimulation Surgery.

Nguyen HS, Woehlck H, Pahapill P - Case Rep Neurol Med (2016)

Bottom Line: Conclusion.The patient had a history of neurocardiogenic syncope and a relatively low-volume state, factors prone to the BJR.Overall, lead implantation can still occur safely if preventive measures are employed.

View Article: PubMed Central - PubMed

Affiliation: Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA.

ABSTRACT
Background. Symptomatic bradycardia and hypotension in neurosurgery can produce severe consequences if not managed appropriately. The literature is scarce regarding its occurrence during deep brain stimulation (DBS) surgery. Case Presentation. A 67-year-old female presented for left DBS lead placement for essential tremors. During lead implantation, heart rate and blood pressure dropped rapidly; the patient became unresponsive and asystolic. Chest compressions were initiated and epinephrine was given. Within 30 seconds, the patient became hemodynamically stable and conscious. A head CT demonstrated no acute findings. After deliberation, a decision was made to complete the procedure. Assuming the etiology of the episode was the Bezold-Jarisch reflex (BJR), appropriate accommodations were made. The procedure was completed uneventfully. Conclusion. The episode was consistent with a manifestation of the BJR. The patient had a history of neurocardiogenic syncope and a relatively low-volume state, factors prone to the BJR. Overall, lead implantation can still occur safely if preventive measures are employed.

No MeSH data available.


Related in: MedlinePlus

CT head demonstrated a small hemorrhage at the tip of the lead.
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fig1: CT head demonstrated a small hemorrhage at the tip of the lead.

Mentions: She underwent a Leksell frame-based placement of a left VIM DBS with microrecording, resulting in a significant lesion effect and intraoperative tremor arrest with macrostimulation. Immediately, postoperatively, the patient demonstrated mild difficulty with coordination and speech production, as well as an odd sensation in the right hand. A CT head demonstrated a small hemorrhage at the tip of the lead (Figure 1). At the first programming session, her initial postoperative symptoms, including her lesion effect, had resolved and she demonstrated no benefits from stimulation. An MRI brain confirmed a small resolving hematoma at the tip of the lead (Figures 2(a) and 2(b)); consequently, further programming was held off until the hematoma resolved. A month later, DBS programming again demonstrated no benefits. Revision surgery was recommended.


An Unusual Case of Asystole Occurring during Deep Brain Stimulation Surgery.

Nguyen HS, Woehlck H, Pahapill P - Case Rep Neurol Med (2016)

CT head demonstrated a small hemorrhage at the tip of the lead.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4863081&req=5

fig1: CT head demonstrated a small hemorrhage at the tip of the lead.
Mentions: She underwent a Leksell frame-based placement of a left VIM DBS with microrecording, resulting in a significant lesion effect and intraoperative tremor arrest with macrostimulation. Immediately, postoperatively, the patient demonstrated mild difficulty with coordination and speech production, as well as an odd sensation in the right hand. A CT head demonstrated a small hemorrhage at the tip of the lead (Figure 1). At the first programming session, her initial postoperative symptoms, including her lesion effect, had resolved and she demonstrated no benefits from stimulation. An MRI brain confirmed a small resolving hematoma at the tip of the lead (Figures 2(a) and 2(b)); consequently, further programming was held off until the hematoma resolved. A month later, DBS programming again demonstrated no benefits. Revision surgery was recommended.

Bottom Line: Conclusion.The patient had a history of neurocardiogenic syncope and a relatively low-volume state, factors prone to the BJR.Overall, lead implantation can still occur safely if preventive measures are employed.

View Article: PubMed Central - PubMed

Affiliation: Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA.

ABSTRACT
Background. Symptomatic bradycardia and hypotension in neurosurgery can produce severe consequences if not managed appropriately. The literature is scarce regarding its occurrence during deep brain stimulation (DBS) surgery. Case Presentation. A 67-year-old female presented for left DBS lead placement for essential tremors. During lead implantation, heart rate and blood pressure dropped rapidly; the patient became unresponsive and asystolic. Chest compressions were initiated and epinephrine was given. Within 30 seconds, the patient became hemodynamically stable and conscious. A head CT demonstrated no acute findings. After deliberation, a decision was made to complete the procedure. Assuming the etiology of the episode was the Bezold-Jarisch reflex (BJR), appropriate accommodations were made. The procedure was completed uneventfully. Conclusion. The episode was consistent with a manifestation of the BJR. The patient had a history of neurocardiogenic syncope and a relatively low-volume state, factors prone to the BJR. Overall, lead implantation can still occur safely if preventive measures are employed.

No MeSH data available.


Related in: MedlinePlus