Cardiac arrhythmia induced by pneumoencephalography.

Area of Science:

• Neurology
• Cardiology
• Medical Imaging

Background:

• Pneumoencephalography (PNE) is a neuroimaging technique that involves replacing cerebrospinal fluid with air.
• Previous reports suggest a link between PNE and cardiovascular complications, but prospective data are lacking.
• Understanding the cardiac risks associated with PNE is crucial for patient safety.

Observation:

• This prospective study monitored the electrocardiograms (ECGs) of 82 patients undergoing PNE under general anesthesia.
• Patients had no pre-existing cardiovascular or metabolic diseases.
• Cardiac rhythm was continuously assessed during and after air injection.

Findings:

• Arrhythmias occurred in 60% of patients following air injection during PNE.
• Specific arrhythmias included bradycardia (22%), ventricular ectopic beats (26%), and nodal rhythm/sinus tachycardia (11%).
• Cardiovascular collapse occurred in three patients, two with "torsades de pointes" and one with bigeminy and QRS block.
• Arrhythmia frequency was significantly higher in patients with pituitary tumors and intracranial hypertension (91%).
• Patients with frontal lobe tumors (3/4) and posterior fossa tumors (4/7) also showed a higher incidence of arrhythmia.

Implications:

• PNE is associated with a high frequency of cardiac arrhythmias, some severe.
• Patients with intracranial hypertension and brain tumors, especially pituitary or posterior fossa tumors, are at increased risk.
• These findings highlight the need for careful cardiac monitoring during and after PNE in at-risk populations.