Republished: Trigeminocardiac reflex caused by selective angiography of the middle meningeal artery

Abstract

We describe an interesting case of trigeminocardiac reflex (TCR) caused by selective angiography of the middle meningeal artery (MMA). A 28-year-old woman presented with a symptomatic meningioma. Preoperative tumour embolisation was performed. In the procedure, when selective MMA angiography was done with Omnipaque 300 mg I/mL for 3 mL by manual injection, the patient complained of flashing lights in her eye followed by vomiting and bradycardia down to 40 bpm without increased intracranial pressure signs. On selective MMA angiography, the choroidal crescent and arteries of the periorbital region were opacified by anastomosis from the MMA via the meningo-ophthalmic artery. We diagnosed that her symptoms were caused by selective MMA angiography leading to high pressure stimulation towards the ophthalmic nerve innervation around the orbit as a TCR. We suggest that the operator should be prepared to manage TCR during treatment with expected selective MMA angiography, and gentle low pressure contrast injection should be attempted.

Brain and Heart Crosstalk During Neurointerventional Procedures: The Role of the Trigeminocardiac Reflex: An Updated Systematic Review

“…The library's advanced search system yielded a total of 232 articles; one additional article was identified as a crossreference. After the removal of duplicates, 90 articles were screened and 18 included in the study 7,8,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] (Fig. 1).…”

Contrast-induced ischemic colitis following coronary angiography: A case report

“…Moreover, Omnipaque can induce changes in intravascular pressure and endothelial permeability. Recently, Omnipaque was reported to induce pituitary apoplexy[ 8 ], status epilepticus[ 9 ], immune hemolytic anemia[ 10 ], trigeminocardiac reflex[ 11 ] and encephalopathy[ 12 ] in some rare cases. In this case, Omnipaque-induced IC remains the most likely diagnosis based on the complete resolution of symptoms with antibiotic therapy and supportive management only.…”

Case Report: Trigeminocardiac Reflex in Endovascular Recanalization of Intracranial Internal Carotid Artery Occlusion

“…In the four cases reported here, three different contrast agents were used, and we therefore cannot conclude that they were responsible for the TCRs. TCR can also be caused by high pressure caused by the manual injection of contrast agents into selected arteries, which can stimulate branches of the trigeminal nerve ( 2 ). Some of the angioarchitectural characteristics were similar among the four cases.…”

“…TCR may occur in a variety of diseases as well as during or after surgery involving the trigeminal nerve (most commonly neurosurgery or ophthalmic surgery). Although rare, TCR can also be encountered during interventional neuroradiology procedures (2)(3)(4)(5).…”