Dadlani Ravi, Challam Koli, Garg Amit, Hegde Alangar S
Department of Pediatrics, Seth G.S. Medical College and KEM Hospital, Mumbai, India.
Indian J Crit Care Med. 2010 Oct;14(4):212-6. doi: 10.4103/0972-5229.76088.
Bradycardia in neurosurgery is almost always assumed to be secondary to intracranial conditions, specifically raised intracranial pressure causing Cushing's reflex, the trigemino-cardiac reflex or brainstem lesions. We present a case of posterior fossa surgery in which persistent bradycardia developed in the postoperative period. A cardiac cause was initially overlooked since hydrocephalus was present preoperatively, which was initially assumed to be the cause of the bradycardia. The baseline pulse rate prior to surgery was 66 beats/minute. Only when repeated imaging revealed complete resolution of the hydrocephalus was a cardiology work up done and diagnosis of sick sinus syndrome established. The authors present an interesting case which demonstrates the need for a high degree of suspicion for such rare co-existing conditions. The diagnostic and management dilemmas are further discussed.
神经外科手术中的心动过缓几乎总是被认为继发于颅内疾病，特别是颅内压升高导致库欣反射、三叉神经-心脏反射或脑干病变。我们报告一例后颅窝手术病例，术后出现持续性心动过缓。由于术前存在脑积水，最初认为是心动过缓的原因，因此最初忽略了心脏原因。手术前的基础心率为66次/分钟。只有当重复成像显示脑积水完全消退时，才进行了心脏检查并确诊为病态窦房结综合征。作者展示了一个有趣的病例，表明对于这种罕见的并存疾病需要高度怀疑。进一步讨论了诊断和管理难题。
