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Intracerebral haematoma masquerading as ventricular standstill
A K J Mandal1, S Baltsezak, C G Missouris
1Department of Cardiology, Wexham Park Hospital, Wexham Street, Slough, Berkshire SL2 4HL, UK. akjm@mac.com
Heart (British Cardiac Society)
|December 18, 2004
Summary
Head injury patients with slow heart rates require prompt evaluation. Early intervention with pacing and conservative management of bleeding can lead to good recovery.
Area of Science:
- Neurology and Cardiology
- Traumatic Brain Injury Management
Background:
- Head injuries can precipitate cardiovascular complications, including bradycardia and sinus arrest.
- The case highlights the importance of recognizing the interplay between neurological trauma and cardiac function.
Observation:
- An 82-year-old male presented with a right frontoparietal headache following a fall, with computed tomography revealing a cortical contrecoup hematoma.
- Electrocardiogram (ECG) showed ventricular standstill, necessitating temporary pacing and subsequent permanent pacemaker implantation.
- Intracerebral bleeding was managed conservatively.
Findings:
- Prompt brain CT is crucial for diagnosing intracerebral hematoma and elevated intracranial pressure in head injury patients.
- Patients with head injury and cardiovascular compromise require multidisciplinary collaboration between neurosurgery and cardiology.
- Urgent pacing is indicated for symptomatic bradycardia or ventricular standstill following head injury.
Implications:
- Patients with head injury and sinus bradycardia/arrest should be nursed at a 15-30 degree elevation, avoiding head-up and supine positions.
- Conservative management of intracerebral bleeding, combined with cardiac support, can result in favorable patient outcomes.
- This case underscores the necessity of immediate cardiac assessment and intervention in head trauma patients presenting with arrhythmias.