RT Journal Article
SR Electronic
T1 Recurrent cardiac arrest caused by lateral medulla oblongata infarction
JF BMJ Case Reports
FD BMJ Publishing Group Ltd
SP bcr0220091625
DO 10.1136/bcr.02.2009.1625
VO 2009
A1 Philipp von Heinemann
A1 Oliver Grauer
A1 Gerhard Schuierer
A1 Markus Ritzka
A1 Ulrich Bogdahn
A1 Bernhard Kaiser
A1 Felix Schlachetzki
YR 2009
UL http://casereports.bmj.com/content/2009/bcr.02.2009.1625.abstract
AB Cardiac arrest is a rare complication in Wallenberg syndrome, despite the fact that the brainstem, especially the lower medulla, modulates sympathetic and parasympathetic activity. In the case reported here, a 45-year-old man was admitted with clinical symptoms of Wallenberg syndrome, including right sided hemiparesis secondary to dissection of the right vertebral artery. During the following days he experienced several spells of self limiting cardiac arrests, which made the implantation of a pacemaker necessary. Magnetic resonance imaging scan showed an infarction on the lower right and dorsolateral medulla. This might have affected the central sympathetic neurons which normally inhibit the nucleus of the solitary tract. The disinhibition of the nucleus tractus solitarii may have led to an increase of parasympathetic outflow resulting in bradycardia/asystolia. This case report describes a rare indication for transient or permanent therapy with a cardiac pacemaker in Wallenberg syndrome.