Nguyen Ha Son, Woehlck Harvey, Pahapill Peter
Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
Anesthesiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
Case Rep Neurol Med. 2016;2016:8930296. doi: 10.1155/2016/8930296. Epub 2016 Apr 27.
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.
背景。神经外科手术中出现的症状性心动过缓和低血压若处理不当可产生严重后果。关于其在脑深部电刺激（DBS）手术期间的发生情况，文献报道较少。病例报告。一名67岁女性因特发性震颤前来接受左侧DBS电极植入。在电极植入过程中，心率和血压迅速下降；患者失去反应且心脏停搏。开始进行胸外按压并给予肾上腺素。30秒内，患者血流动力学恢复稳定且意识恢复。头颅CT未显示急性病变。经讨论后，决定完成手术。假设该事件的病因是贝佐尔德－雅里什反射（BJR），采取了适当的应对措施。手术顺利完成。结论。该事件符合BJR的表现。患者有神经心源性晕厥病史且血容量相对较低，这些因素易引发BJR。总体而言，若采取预防措施，电极植入仍可安全进行。
