Acute intraoperative neurogenic myocardial stunning during intracranial endoscopic fenestration and shunt revision in a pediatric patient

Abstract

Neurogenic stunned myocardium (NSM) is syndrome of myocardial dysfunction following an acute neurological insult. We report a case of NSM that occurred intraoperatively in a pediatric patient undergoing endoscopic fenestration and shunt revision. Accidental outflow occlusion of irrigation fluid and ventricular distension resulted in an acute increase in heart rate and arterial blood pressure. Subsequently, the patient developed stunned myocardium with global myocardial hypokinesia and pulmonary edema. She was promptly treated intraoperatively then admitted to the pediatric intensive care unit with resolution of her symptoms within 12 h. She was later discharged to home on the fourth postoperative day. In the current endoscopic era, this report highlights the possibility of intraoperative NSM and neurogenic pulmonary edema in the pediatric population. Early detection and treatment with a team approach help to achieve optimal control of this life-threatening condition and improve the outcome.

An Adult Female with Obstructive Hydrocephalus who Presented with Neurogenic Stunned Myocardium during a Neuroendoscopic Procedure: A Case Report

“…NSM has been reported to occur intraoperatively during an endoscopic shunt revision on a 10-year-old with congenital hydrocephalus wherein rapid influx of irrigating fluid with accidental occlusion of the drainage port resulted in marked hypertension (255/155 mmHg) and tachycardia (138 bpm). 13 A review article stated that a sudden increase in ICP due to high-speed irrigation or obstruction of fluid outflow during neuroendoscopic procedures are primary causes for cardiovascular responses including tachycardia and hypertension. 14 While there are no formal diagnostic criteria for NSM, widely-used indicators include ECG changes (QT prolongation, T-wave inversion and ST-segment changes), decreased cardiac function, elevated troponin levels and ventricular dysfunction.…”

“…NSM is reversible and treatment is primarily supportive in nature. 4,[7][8][9]13 However, if not recognized and managed appropriately, it can be fatal. 18 Patients with underlying acute neurologic injury should have cardiac evaluation upon admission and must be monitored closely as early recognition and management of NSM leads to a favorable outcome.…”

Stress cardiomyopathy in the paediatric population: a case series

“…There is limited data on paediatric stress cardiomyopathy characteristics, but it is relatively prevalent, especially in severe acute neurological diseases. 14 , 15 Our aim is to describe all cases of paediatric stress cardiomyopathy admitted to our paediatric intensive care unit (PICU) from January 2015 to July 2018, regardless of cause, to better understand the circumstances and clinical situations in which this syndrome manifests in children.…”

Neurological Perspectives of Neurogenic Pulmonary Edema

“…However, it can be assumed that many cases have been missed due to the interpretation of lung edema as cardiogenic following heart failure from TTS. Additionally, several cases with TTS and lung edema have been reported without specifying if lung edema fulfilled the diagnostic criteria for NPE or not [38][39][40]. Arguments for a common pathophysiology are that the triggers can be the same and that the frequency of cerebral triggers is similar.…”