Simultaneous Occurrence of Transient Complete Heart Block With Acute Lateral Medullary Infarct
Vishwa Pakeerathan1,2, Abdul Rahman Mohammed2, Rahil Moriswala2
1Medicine, Princess Alexandra Hospital, Brisbane, AUS.
Insights
Lateral Medullary Syndrome (LMS) can cause rare cardiac issues like transient high-grade atrioventricular block (HgAVB). This case highlights the need for cardiac monitoring in LMS patients due to potential autonomic dysregulation.
Area of Science:
- Neurology
- Cardiology
- Neuroscience
Background:
- Lateral Medullary Syndrome (LMS) is a neurological condition often caused by ischemic stroke in the brainstem.
- Cardiac manifestations, particularly arrhythmias, are recognized but rare complications of LMS.
Observation:
- A unique case of LMS in a woman in her 60s presented with neurological deficits and a transient high-grade atrioventricular block (HgAVB).
- The patient experienced sudden onset of severe headache and left-sided weakness, indicative of an acute infarct in the medulla.
- The HgAVB spontaneously resolved within 72 hours, a rare occurrence alongside acute lateral medullary infarct.
Findings:
- This case documents the simultaneous occurrence of acute lateral medullary infarct and transient high-grade atrioventricular block.
- The co-occurrence is exceptionally rare, with few similar case reports in existing medical literature.
- Autonomic dysregulation secondary to brainstem involvement is proposed as a potential mechanism linking LMS and cardiac abnormalities.
Implications:
- Extended cardiac surveillance is crucial for LMS patients due to their susceptibility to potentially life-threatening arrhythmias.
- The findings underscore the complex interplay between the brainstem and the cardiovascular system.
- A holistic, interdisciplinary approach to LMS management is advocated to improve patient outcomes and mitigate risks of fatal arrhythmias.
Abstract:
Lateral Medullary Syndrome (LMS) poses clinical challenges, often resulting from ischemic events in the medulla oblongata. We present a unique case of LMS in a woman in her 60s with a complex medical history. Alongside neurological deficits, she experienced a transient high-grade atrioventricular block (HgAVB), a rare cardiac manifestation linked to LMS. Given the rarity of simultaneous transient HgAVB with acute lateral medullary infarct, only a handful of case reports documenting similar findings are available in the existing literature. More research and case reporting are needed to better our understanding of this area. The patient's condition, marked by a sudden onset of severe headache and left-sided weakness, revealed an acute infarct in the medulla territory. Notably, her HgAVB spontaneously resolved after 72 hours. This case emphasises the crucial need for extended cardiac surveillance in LMS patients due to their susceptibility to life-threatening arrhythmias. The intricate interplay between the brainstem and cardiovascular system highlights autonomic dysregulation as a potential mechanism for cardiac abnormalities. The report advocates for a holistic approach to managing LMS cases, stressing interdisciplinary collaboration for timely diagnosis and intervention, ultimately improving patient outcomes and reducing the risk of fatal arrhythmias.
