Asphyxia due to laryngeal spasm as a severe complication of awake deep brain stimulation for Parkinson's disease: a case report.
BACKGROUND
In accordance with German neurosurgical and neurological consensus recommendations, lead placements for deep brain stimulation (DBS) in patients with Parkinson's disease (PD) are usually performed with the patient awake and in "medication off" state. This allows for optimal lead position adjustment according to the clinical response to intraoperative test stimulation. However, exacerbation of Parkinsonian symptoms after withdrawal of dopaminergic medication may endanger the patient by inducing severe "off" state motor phenomena. In particular, this can be a problem in awake craniotomies utilizing intraoperative airway management and resuscitation.


METHODS
We report the case of a PD patient with progressive orofacial and neck muscle dystonia resulting in laryngeal spasm during DBS lead placement. This led to upper airway compromise and asphyxia, requiring resuscitation.


CONCLUSIONS
Laryngeal spasms may occur as a rare "off" state motor complication in patients with PD. Other potential causes of intraoperative difficulties breathing include bilateral vocal cord palsy, positional asphyxia, and silent aspiration. In our practice, we have adjusted our medication regimen and now allow patients to receive their standard dopaminergic medication until the morning of surgery. Neurologists and neurosurgeons performing lead placement procedures for PD should be aware of this rare but unsafe condition to most optimized treatment.
Department of Neurosurgery, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany. kajetan.voneckardstein@med.uni-goettingen.de.
Kajetan L
KL
von Eckardstein
Paracelsus Elena-Klinik, Kassel, Germany.
Friederike
F
Sixel-Döring
Department of Anasthesiology, Universitätsmedizin Göttingen, Göttingen, Germany.
Stephan
S
Kazmaier
Department of Neurosurgery, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.|Paracelsus Elena-Klinik, Kassel, Germany.
Claudia
C
Trenkwalder
The Texas Brain and Spine Institute, Bryan, TX, USA.
Jason M
JM
Hoover
Department of Neurosurgery, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
Veit
V
Rohde
D001237:Asphyxia / Q000175:diagnosis / Q000209:etiology; D016887:Cardiopulmonary Resuscitation; D046690:Deep Brain Stimulation / Q000009:adverse effects* / Q000379:methods; D003937:Diagnosis, Differential; D006801:Humans; D007826:Laryngismus / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000628:therapy*
Asphyxia; Complication; Deep brain stimulation; Laryngeal spams; Parkinson’s disease