title: Macroglossia associated with brainstem injury.
abstract: BACKGROUND
  Macroglossia has been reported in patients undergoing posterior fossa neurosurgical procedures and is thought to be as a result of venous engorgement from intubation or mechanical positioning during these prolonged procedures.
  
  
  METHODS
  We report three patients who developed macroglossia and dysautonomia of central neurogenic origin following brainstem injury.
  
  
  RESULTS
  The three patients developed macroglossia and dysautonomia with wide hemodynamic fluctuations in the setting of posterior fossa injury of the lower brainstem structures, necessitating tracheostomy placement. Macroglossia was managed with dexamethasone and there was complete resolution of dysautonomia while treated with beta-blockers and gabapentin.
  
  
  CONCLUSIONS
  Neurointensivists should be aware of macroglossia with dysautonomia complicating brainstem injury, which may have perilous consequences in the setting of cerebral edema or intracranial hypertension.
authors.affiliation: Division of Neurocritical Care, Department of Neurology, Ochsner Medical Center, New Orleans, LA, USA, iiwuchuk@tulane.edu.
authors.forename: Ifeanyi
authors.initials: I
authors.lastname: Iwuchukwu
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Ardelt
authors.forename: Wilson
authors.initials: W
authors.lastname: Cueva
authors.forename: Rwoof
authors.initials: R
authors.lastname: Reshi
authors.forename: Fernando
authors.initials: F
authors.lastname: Goldenberg
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Frank
mesh_terms: D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000588:Amines / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001930:Brain Injuries / Q000150:complications* / Q000209:etiology; D001933:Brain Stem / Q000293:injuries*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D003388:Cranial Fossa, Posterior / Q000293:injuries; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D005260:Female; D000077206:Gabapentin; D006801:Humans; D008260:Macroglossia / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D054969:Primary Dysautonomias / Q000188:drug therapy / Q000209:etiology; D014139:Tracheostomy / Q000379:methods; D016896:Treatment Outcome; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
chemical_list: D000319:Adrenergic beta-Antagonists; D000588:Amines; D000893:Anti-Inflammatory Agents; D002121:Calcium Channel Blockers; D003509:Cyclohexanecarboxylic Acids; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D003907:Dexamethasone