Patients repeated cardiac arrest, the original is this common cerebral infarction caused by the scourge!

In brain stem syndrome, the familiarity of Wallenberg syndrome, also known as myelin-back syndrome, can be rated as five starsGiven the complexity of the structure and complexity of the syndrome, it is a classic in neurologyfrom the student era to the clinical post, this concept has taken root in everyone's heartsEven the variants of Wallenberg syndrome are familiarSo wallenberg syndrome causes repeated cardiac arrest, have you ever heard of it?1Wallenberg syndrome
look back at the classic Wallenberg syndromeacute stroke, vertebral artery mezzanine can cause Wallenberg syndrome, which is fed by the lower arteries of the cerebellumClassic clinical manifestations are five major symptoms and signs:vertigo, nausea, vomiting and eye shock (frontal nerve damage);lesions side soft palate, throat paralysis, performance of dysphagia, sound disorder, isophthalism and pharynx reflexes disappear (suspected nuclei and tongue, vagus nerve damage)disease) Side side of the lesions (rope damage);of horner syndrome (sympathetic nerve downstream fiber damage);cross-sensory disorder, i.e side pain, loss of temperature perception (trigeminal nerve and spinal nuclear damage), side side pain, hypothermia or loss (spinal hypothalamus side beam damage) 2 wallenberg syndrome patients with repeated cardiac arrest Next, let's look at a Wallenberg syndrome patient with repeated cardiac arrest, from BMJ Case Report, which we have simplified for ease of understanding patient, a 45-year-old male with right hand, suddenly appeared with right limb paraplegia while wrestling with his son The patient is unconsciously lossy or nauseous There is no speciality in the past to carry out physical examination of patients, right upper limb, lower limb weakness The patient's right face felt loss, while the left body temperature loss, the examination also found the right side of Horner syndrome patients' clinical performance is basically consistent with Wallenberg syndrome patients suddenly nausea, and loss of consciousness, on the electrocardiogram showed a self-limiting time of 10s cardiac arrest (Figure 1), within 48 hours the patient had a similar three cardiac arrest, for the patient arranged for the patient cardiology consultation An electrocardiogram showed a cardiac arrest of up to 10s (pictured in the literature) but after various tests, including chest and esophagus cardiac ultrasound, doctors did not find a change in cardiology that ruled out cardiac arrest due to heart disease In order to solve the problem of repeated cardiac arrest, medical staff implanted a temporary pacemaker for the patient patients underwent a craniofacial MR examination, which showed an external infarction on the right myelin back (Figure 2) MRA sees stenosis of the right vertebral artery, suggesting that the vertebral artery mezzanine, which may be caused when the patient wrestles with his son the pacemaker was removed after 7 days, and the patient underwent 6 months of anticoagulant therapy and continued oral aspirin After 12 months, the patient was re-diagnosed and heart complications did not occur again Figure 2 MR shows the possible causes of repeated cardiac arrest 3 in the literature (pictured) how wallenberg syndrome causes cardiac arrest? The answer is that the detailed mechanism has not yet been clearly explained But don't lose heart, the existing knowledge system can give us some explanation is known as the "life center" and is one of the regulating areas of the input and output of the autonomic nervous system (sympathetic nervous system and parasympathetic nervous system) The eternity is the center of stress-receptor reflex, one of the effects of stress-reflex, which causes blood pressure to drop and heart rate to slow down when arterial blood pressure rises shown in the figure below (Figure 3), in the elongation, the solitary beam core, on the one hand, inhibits the sympathetic output neurons through inhibition projection, and enhances the parasympathetic output neurons (mainly the suspect nucleus and the vagus nerve back core) on the other hand through excitatory projection simply is that the lone-beam nuclear excitement can be later to soothe the restless sympathetic nerves, while the suppression of the heart, blood vessels of the side of the sympathetic nerve to play a role, and ultimately achieve the heart rate slow, blood pressure drop purposes Arterial blood pressure increases, the lone beam nuclear inhibits the cross-amusing activity, enhances the paracontoma activity (pictured from the literature 1) in other words, if the extension of myelin some pathological changes, so that the solitary beam nuclear further function, will produce inhibition of heart function, such as tachycardia and even cardiac arrest the aforementioned cases, we speculate that the patient's myelin infarction led to the inhibition of the solitary beam nucleus relief, and then the solitary beam nucleus can "extraordinary play", the interaction outflow is blocked, and the side effect is greatly enhanced, the patient showed repeated cardiac arrest the treatment of patients, in addition to the nervous system-assisted examination, cardiology consultation and cardiac assisted examination is essential ECG monitoring or dynamic electrocardiograms should be performed on patients with Wallenberg syndrome, and it is sometimes necessary to implant a pacemaker after a cardiac arrest is found The concept of Wallenberg syndrome has taken root in everyone's mind, and the spring will be exhausted, and this case is a new shoot in the old tree Author: HH Source: , , , , commented on the of (from: MedSci Medical App )