Abstract
IntroductionThe trigemino-cardiac reflex is defined as the sudden onset of parasympathetic dysrhythmia, sympathetic hypotension, apnea, or gastric hypermotility during stimulation of any of the sensory branches of the trigeminal nerve. Clinically, trigemino-cardiac reflex has been reported to occur during neurosurgical skull-base surgery. Apart from the few clinical reports, the physiological function of this brainstem reflex has not yet been fully explored. Little is known regarding any predisposing factors related to the intraoperative occurrence of this reflex.Case presentationWe report the case of a 70-year-old Caucasian man who demonstrated a clearly expressed form of trigemino-cardiac reflex with severe bradycardia requiring intervention that was recorded during surgical removal of a large subdural empyema.ConclusionTo the best of our knowledge, this is the first report of an intracranial infection leading to perioperative trigemino-cardiac reflex. We therefore add a new predisposing factor for trigemino-cardiac reflex to the existing literature. Possible mechanisms are discussed in the light of the relevant literature.
Highlights
The trigemino-cardiac reflex is defined as the sudden onset of parasympathetic dysrhythmia, sympathetic hypotension, apnea, or gastric hypermotility during stimulation of any of the sensory branches of the trigeminal nerve
Case presentation: We report the case of a 70-year-old Caucasian man who demonstrated a clearly expressed form of trigemino-cardiac reflex with severe bradycardia requiring intervention that was recorded during surgical removal of a large subdural empyema
To the best of our knowledge, this is the first report of an intracranial infection leading to perioperative trigemino-cardiac reflex
Summary
To the best of our knowledge, this is the first report of an intracranial infection with the intra-operative occurrence of TCR during a routine neurosurgical maneuver. Infected (intracranial) tissue may be a new and important predisposing factor for the occurrence of TCR, a phenomenon that is different from the falcine TCR caused by bilateral stimulation of tentorial nerve that was described earlier. Further laboratory and clinical investigations are needed to clarify this new information about TCR. Consent Written informed consent was obtained form the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-chief of this journal
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