ABSTRACT
A 65-year-old man experienced syncope associated with advanced atrioventricular (AV) block upon swallowing. Continuous electrocardiogram (ECG) monitoring revealed first and second degree AV block. ECG revealed advanced AV block (Max R-R 6.38 s) upon swallowing, a cold drink. Demand ventricular pacing alleviated his symptoms. In this patient, the advanced AV block might have been precipitated by a vagovagal reflex triggered by expansion of the esophagus, resulting in selective suppression of the atrioventricular node.
Subject(s)
Deglutition/physiology , Reflex/physiology , Syncope/etiology , Vagus Nerve/physiopathology , Aged , Atrioventricular Node/physiopathology , Cardiac Pacing, Artificial , Esophagus/innervation , Esophagus/physiopathology , Heart Block/etiology , Heart Block/physiopathology , Heart Block/therapy , Humans , Male , Syncope/physiopathology , Syncope/therapyABSTRACT
We report a rare case of syringomyelia associated with postoperative adhesive arachnoiditis and an extradural cyst. A 61-year-old male was admitted to our hospital five years after surgical removal of a cervical neurinoma. He complained of progressive quadriparesis and sensory disturbance. A CT scan showed a large cyst posteriorly within the C2, 3, 4 laminectomy area. MRI revealed syringomyelia with an extradural cyst at the C2, 3, 4 level. The operative findings revealed adhesive arachnoiditis on the dorsal surface at the C2, 3, 4 level and an extradural cyst communicating with the subarachnoid space through a dural defect on the left side of the C2 level. By excision of the extradural cyst and placement of a syringo-cisternal shunt, the syringomyelia shrank and the extradural cyst disappeared. It can be speculated that the pathogenesis of syringomyelia in this case was associated with ischemic change of the spinal cord due to compression and constriction caused by the extradural cyst and adhesive arachnoiditis.
Subject(s)
Arachnoiditis/etiology , Cysts/etiology , Postoperative Complications , Syringomyelia/etiology , Epidural Space , Humans , Male , Middle Aged , Neurilemmoma/surgery , Spinal Cord Neoplasms/surgery , Tissue Adhesions/etiologyABSTRACT
Two closed head injury patients who talked before their conditions deteriorated to a Glasgow coma scale score of 8 or less were identified. A 68-year-old man died with delayed traumatic intracerebral hematoma and a 63-year-old man was left vegetative with intracerebral hematoma after surgical decompression. Intracerebral hematomas in the elderly are significantly more common in the "talk and deteriorate" group, and rapid diagnosis by repeated CT scan and decompression are the most important factor in salvaging these patients.