Asystole as a neurologic sign

The authors present a case of asystole occurring during dural closure following craniotomy with the patient in the supine position. This 22-year-old woman had a left parietal lobe tumor resected with bipolar cautery. Standard intraoperative monitoring with a left radial arterial line and a right internal jugular central venous catheter was used during the surgery. The anesthetic course was complicated by intraoperative bleeding that responded to three units of fresh frozen plasma. Prior to closure, the operative site appeared dry and intact. After closure, asystole occurred suddenly and resolved with evacuation of 500 ml of blood. It is speculated that the asystole was preceded by an acute increase in intracranial pressure and a subsequent secondary brainstem compression.