An Unusual Case of Asystole Occurring during Deep Brain Stimulation Surgery

Area of Science:

• Neurosurgery
• Cardiology
• Neurology

Background:

• Symptomatic bradycardia and hypotension pose significant risks during neurosurgical procedures.
• Limited literature exists on the occurrence of these events during deep brain stimulation (DBS) surgery.

Purpose of the Study:

• To report a case of severe bradycardia and hypotension during DBS surgery.
• To discuss the potential role of the Bezold-Jarisch reflex (BJR) in this event.
• To highlight safety considerations for completing DBS procedures after such an episode.

Main Methods:

• A case presentation of a 67-year-old female undergoing DBS lead placement for essential tremors.
• Description of the intraoperative event: rapid heart rate and blood pressure drop, unresponsiveness, and asystole.
• Management details: cardiopulmonary resuscitation, epinephrine administration, and diagnostic imaging (head CT).

Main Results:

• The patient experienced rapid hemodynamic deterioration, consistent with the Bezold-Jarisch reflex (BJR).
• Immediate resuscitation measures successfully stabilized the patient within 30 seconds.
• The DBS procedure was safely completed after addressing the suspected BJR and implementing preventive measures.

Conclusions:

• The intraoperative event was likely a manifestation of the Bezold-Jarisch reflex (BJR), influenced by patient history (neurocardiogenic syncope) and physiological state (low-volume).
• Deep brain stimulation lead implantation can be performed safely, even after experiencing BJR-related complications, with appropriate precautions.