title: Acute intraoperative neurogenic myocardial stunning during intracranial endoscopic fenestration and shunt revision in a pediatric patient.
abstract: Neurogenic stunned myocardium (NSM) is syndrome of myocardial dysfunction following an acute neurological insult. We report a case of NSM that occurred intraoperatively in a pediatric patient undergoing endoscopic fenestration and shunt revision. Accidental outflow occlusion of irrigation fluid and ventricular distension resulted in an acute increase in heart rate and arterial blood pressure. Subsequently, the patient developed stunned myocardium with global myocardial hypokinesia and pulmonary edema. She was promptly treated intraoperatively then admitted to the pediatric intensive care unit with resolution of her symptoms within 12 h. She was later discharged to home on the fourth postoperative day. In the current endoscopic era, this report highlights the possibility of intraoperative NSM and neurogenic pulmonary edema in the pediatric population. Early detection and treatment with a team approach help to achieve optimal control of this life-threatening condition and improve the outcome.
authors: Department of Anesthesiology, West Virginia University, School of Medicine, 1 Medical Center, PO Box 8255, Morgantown, WV, 26506, USA. dragank@wvuhealthcare.com.
authors: Kristen Elizabeth
authors: KE
authors: Dragan
authors: Department of Pediatrics, Section of Critical Care Medicine, West Virginia University, Morgantown, WV, USA. wpatten@hsc.wvu.edu.
authors: William D
authors: WD
authors: Patten
authors: Department of Anesthesiology, West Virginia University, School of Medicine, 1 Medical Center, PO Box 8255, Morgantown, WV, 26506, USA. zamzamyo@wvuhealthcare.com.
authors: Osama M
authors: OM
authors: Elzamzamy
authors: Department of Anesthesiology, West Virginia University, School of Medicine, 1 Medical Center, PO Box 8255, Morgantown, WV, 26506, USA. attaallaha@wvuhealthcare.com.
authors: Ahmed Fikry
authors: AF
authors: Attaallah
mesh_terms: D002648:Child; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D017682:Myocardial Stunning / Q000209:etiology*; D011654:Pulmonary Edema / Q000209:etiology*; D012086:Reoperation
keywords: Endoscope; Fenestration; Intracranial pressure; Pediatric; Takotsubo cardiomyopathy