Neurogenic stunned myocardium: an unusual postoperative complication

In this report of myocardial dysfunction in a pediatric patient after a neurosurgical procedure, we highlight the need for high clinical suspicion for neurogenic stunned myocardium.

Case report.

A tertiary pediatric intensive care unit.

A 7-yr-old boy with a history of Chiari malformation type 1, undergoing his fourth surgical procedure, who developed signs of myocardial infarction in the immediate postoperative period.

Serial echocardiograms, a rest-stress myocardial perfusion study, and coronary angiography were performed. Serial troponins were followed.

The troponin level normalized 6 days after the initial event, and he was discharged home on a limited course of lisinopril, propanolol, and aspirin and without signs or symptoms of cardiac dysfunction.

Neurogenic stunned myocardium is an uncommon event after neurosurgical procedures in children. Pediatric intensivists need to consider this diagnosis in a patient with signs of myocardial dysfunction in the neurosurgical postoperative period. The management of neurogenic stunned myocardium involves close monitoring and establishing the absence of other causes of myocardial ischemia.