A CASE OF SUDDEN CARDIORESPIRATORY ARREST IN LATERAL MEDULLARY SYNDROME


Shiju Kodimattathil Sleeba, A.k. Mohammed Musthafa, Dipu K.p, P.a Kabeer

Abstract


Sudden cardiorespiratory arrest can occur several days after lateral medullary infarction especially when the patients were both medically and
neurologically stable after a stroke which caused only minimal motor disability. Cardiac arrhythmia is among one of the mechanisms by which
cardiorespiratory arrest have occurred. Another cause is that the lateral medullary infarction and surrounding brain tissue (possibly ischemic
penumbra) may have affected the brain stem cardiac and respiratory centers together with autonomic pathways. Medullary lesions can cause
autonomic instability which can precipitate death in each case. It is plausible that ischemic lesions of the solitary tract nuclei result initially with some
lateral medullary infarctions, and that such lesions may in turn precipitate some occurrences of cardiorespiratory arrest. 54-years-old male presented
with difficulty in swallowing, hoarseness of voice, vomiting, difficulty in walking and sitting upright. On the evaluation, he had left sided central facial
nerve palsy, paralysis of the left soft palate, dysphagia, decreased pain and temperature sensation over the left face and upper limb, and cerebellar
signs (dysdiadochokinesia and past pointing) in the left upper limb and truncal ataxia. Magnetic resonance imaging disclosed high intensity area in
the left lateral and dorso-medial medulla in T2-weighted image. He developed rapidly progressive respiratory failure followed by sudden cardiorespiratory
arrest. He was resuscitated and put on mechanical ventilation. He further developed severe hypotension not responding to intravenous
inotropic supports. On 3rd day of hospital stay, he developed sudden cardiac arrest. Autonomic instability and sudden cardiorespiratory arrest which
are rare manifestations of lateral medullary syndrome have occurred together in this patient.

Keywords: India, Kerala, Kottakkal, lateral medullary syndrome, Malappuram, Ondine’s curse, sudden cardiorespiratory arrest


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References


Smith TW (1998) Arrhythmia mechanism of unexpected sudden death following lateral medullary infarction. Tenn Med 91:284.

DeCaro R, Parenti A, Montisci M, et al. (2000) Solitary tract nuclei in acute heart failure.Stroke 31:1187–1193.

Fitzek S, Fitzek C, Marx J, et al.(1999) Blink reflex R2 changes and localisation of lesions in the lower brainstem (Wallenberg's syndrome): an electrophysiological and MRI study. J Neurol Neurosurg Psychiatry 67:630–636.

Jaster JH, Porterfield LM, Bertorini TE, et al. (1995) Cardiac arrest following vertebrobasilar stroke. Journal of the Tennessee Medical Association 88:309.

Jaster JH, Porterfield LM, Bertorin TE, et al. (1996) Stroke and cardiac arrest [letter]. Neurology 47:1357.

Jaster JH, Smith TW (1998) Arrhythmia mechanism of unexpected sudden death following lateral medullary infarction. Tenn Med 91:284.

Jaster JH, Smith TW, Gleckman AM (2000) A medullary syndrome characterized by wild arm ataxia [letter]. Neurology 55:321.




About this article

Title

A CASE OF SUDDEN CARDIORESPIRATORY ARREST IN LATERAL MEDULLARY SYNDROME

Date

02-09-2014

Additional Links

Manuscript Submission

Journal

Asian Journal of Pharmaceutical and Clinical Research
Vol 7 Issue 4 ( September - October ) 2014 Page: 1-2

Print ISSN

0974-2441

Online ISSN

2455-3891

Statistics

154 Views | 522 Downloads

Authors & Affiliations

Shiju Kodimattathil Sleeba
Almas Hospital, Malappuram, Kerala
India

A.k. Mohammed Musthafa
Almas Hospital, Malappuram, Kerala
India

Dipu K.p
Almas Hospital, Malappuram, Kerala
India

P.a Kabeer
Almas Hospital, Malappuram, Kerala
India


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