An Unusual Case of Asystole Occurring during Deep Brain Stimulation Surgery

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 placeme...

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Bibliographic Details
Published in:Case reports in neurological medicine 2016-01, Vol.2016 (2016), p.1-5
Main Authors: Nguyen, Ha Son, Pahapill, Peter A., Woehlck, Harvey
Format: Article
Language:English
Subjects:
Cardiac arrhythmia
Case Report
Development and progression
Electrodes
Embolisms
Epinephrine
Fainting
Heart beat
Heart rate
Neurosurgery
Patients
Surgery
Tremor
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Summary: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.
ISSN:2090-6668
2090-6676
DOI:10.1155/2016/8930296