title: Cardiac arrest after traffic accident induced through vagal reflex in a case with bilateral stenosis of vertebral arteries.
abstract: An 84-year-old driver suffered cardiac arrest after a traffic accident. He was quickly resuscitated and transferred to a hospital where he was treated in a state of unconsciousness and respiratory failure for 20 days until his death. The brain stem was rendered anoxic during cardiac arrest, which caused the respiratory failure. Artificial ventilation and catecholamine infusion were carried out, resulting in myocardial degeneration. Bilateral stenosis of the vertebral arteries was disclosed, but no injuries or hemorrhage of the brain and spinal cord were detected. On days 3 and 4 after admission, immediately after the head of the victim was flexed forward for examinations, cardiac arrest was induced twice, but was controlled either by administering atropine or by restoring the original posture. Positional change is known to induce vagal reflex that results in bradycardia, hypotension or cardiac arrest in sensitive persons. The victim might have undergone the reflex-mediated cardiac arrest after the accident, to which the stenosis of the vertebral arteries may have contributed.
authors.affiliation: Department of Legal Medicine, Yamaguchi University School of Medicine, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Yoshida
authors.forename: K
authors.initials: K
authors.lastname: Harada
authors.forename: T
authors.initials: T
authors.lastname: Makisumi
authors.forename: Y
authors.initials: Y
authors.lastname: Sorimachi
authors.forename: A
authors.initials: A
authors.lastname: Tateishi
authors.forename: T
authors.initials: T
authors.lastname: Ishihara
authors.forename: T
authors.initials: T
authors.lastname: Maekawa
mesh_terms: D000063:Accidents, Traffic; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D006323:Heart Arrest / Q000209:etiology*; D006801:Humans; D008297:Male; D011187:Posture / Q000502:physiology; D012018:Reflex / Q000502:physiology*; D014630:Vagus Nerve / Q000502:physiology*; D014711:Vertebral Artery / Q000502:physiology*; D014715:Vertebrobasilar Insufficiency / Q000150:complications* / Q000503:physiopathology