scholarly journals Coronary Spasm in Neurosurgical Patients and Role of Trigeminocardiac Reflex

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Tumul Chowdhury ◽  
Cyrill Meuwly ◽  
Nora Sandu ◽  
Ronald B. Cappellani ◽  
Bernhard Schaller
Keyword(s):  
Trigeminal Nerve ◽  
Case Reports ◽  
Coronary Artery Spasm ◽  
Coronary Spasm ◽  
Experimental Studies ◽  
Physiological Mechanism ◽  
Neurosurgical Procedures ◽  
Trigeminocardiac Reflex ◽  
Neurosurgical Patients

Background.Coronary artery spasm (CAS) is a rarely reported complication in neurosurgical patients and its main causative mechanism was attributed to vagal mediated responses. However, these may be the unusual manifestations of trigeminal cardiac reflex (TCR) which is a well established brain stem reflex observed in various neurosurgical patients.Methods and Results.In this review, we have searched for the case reports/papers related to intraoperative coronary spasm in neurosurgical patients and described the role of TCR in this regard. TCR is a possible mechanism in producing CAS in most of the cases in which stimulation occurred at or near the vicinity of trigeminal nerve. It is likely that TCR mediated coronary spasm may be a physiological mechanism and not related to actual myocardial insult apparent by cardiac enzymes or echocardiography studies in most of the cases. Some common risk factors may also exist related to occurrence of CAS as well as TCR.Conclusions.In conclusion, neurosurgical procedures occurring at the vicinity of trigeminal nerve may produce CAS even in previously healthy patients and may produce catastrophic consequences. There is a need for future reports and experimental studies on the interaction of TCR and pathophysiological mechanisms related to CAS.

scholarly journals COVID-19 Pneumonia with Atrial Fibrillation, Coronary Spasm, and Wavy Triple Sign (Yasser’s Sign); Dramatic Reversal at Home Management

2021 ◽  
pp. 20-23
Author(s):  
Yasser Mohammed Hassanain Elsayed
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Artery Spasm ◽  
Coronary Spasm ◽  
Initial Therapy ◽  
Good Prognosis ◽  
Elderly Male ◽  
St Segment

Rationale: A novel COVID-19 with a severe acute respiratory syndrome or pneumonia had arisen in Wuhan, China in December 2019. Emerging atrial fibrillation in COVID-19 patients is highly significant in cardiovascular medicine. A newly coronary artery spasm in the presentation of COVID-19 infection has certainly a risk impact on both morbidity and mortality of COVID-19 patients. Wavy triple an electrocardiographic sign (Yasser Sign) is an innovated sign of hypocalcaemia linked to tachypnea and acute respiratory distress. Patient concerns: An elderly male COVID-19 patient presented to physician outpatient clinic with bilateral pneumonia, atrial fibrillation, evidence of coronary artery spasm, and Wavy triple an electrocardiographic sign (Yasser Sign). Diagnosis: COVID-19 pneumonia with coronary artery spasm and the Wavy triple an electrocardiographic sign (Yasser Sign). Interventions: Chest CT scan, electrocardiography, oxygenation, and echocardiography. Outcomes: Gradual dramatic clinical, electrocardiographic, and radiological improvement had happened. Lessons: The reversal of electrocardiographic ST-segment depressions in a COVID-19 patient after adding oral nitroglycerine is an indicator for the presence of coronary artery spasm. It signifies the role of the anti-infective drugs, anticoagulants, antiplatelet, and steroids in COVID-19 patients with bilateral pneumonia, AF, coronary artery spasm are effective therapies. The disappearance of AF after initial therapy may a guide for a good prognosis in this case study. The evanescence of Wavy triple ECG sign as a hallmark for the existence of the Movable-weaning phenomenon of hypocalcaemia is recommended for further wide-study.

scholarly journals Trigeminocardiac reflex during surgery in the cerebellopontine angle

1998 ◽  
Vol 5 (3) ◽  
pp. E9 ◽  
Author(s):  
Bernhard Schall ◽  
Rudolf Probst ◽  
Stephan Strebel ◽  
Peter Fuhr ◽  
Otmar Gratzl
Keyword(s):  
Blood Pressure ◽  
Trigeminal Nerve ◽  
Cerebellopontine Angle ◽  
Experimental Studies ◽  
Ocular Surgery ◽  
Trigeminocardiac Reflex ◽  
Arterial Blood ◽  
Nerve System ◽  
Central Stimulation ◽  
Stimulation Of

In different experimental studies authors have analyzed the autonomic responses elicited by the electrical, mechanical, or chemical stimulation of the trigeminal nerve system. The trigeminocardiac reflex (TCR) is a well-recognized phenomenon that consists of bradycardia, arterial hypotension, apnea, and gastric hypermotility. It occurs during ocular surgery and during other manipulations in and around the orbit. Thus far, it has not been shown that central stimulation of the trigeminal nerve can also cause this reflex. The TCR was defined as clinical hypotension with a drop in mean arterial blood pressure (MABP) of more than 20% and bradycardia lower than 60 beats/minute. Pre-, intra-, and postoperative heart rate (HR) and blood pressure were reviewed retrospectively in 125 patients who underwent surgery for tumors of the cerebellopontine angle (CPA), and they were divided into a TCR group and a non-TCR group. Of the 125 patients, 14 (11%) showed evidence of TCR during dissection of the tumor near the trigeminal nerve at the brainstem. Their HR fell 38% and their MABP fell 48% during operative procedures as compared with preoperative levels. After cessation of manipulation, the HR and the MABP returned to preoperative levels. Risk factors for the occurrence of TCR were compared with results from the literature. The authors' results show the possibility of occurrence of a TCR during manipulation of the central part of the trigeminal nerve when performing surgery in the CPA.

scholarly journals Mimic high lateral myocardial infarction in chest tetany with mirror electrocardiographic change, Movable phenomenon (Yasser’s phenomenon), and coronary spasm; dramatic Oxygen reversal

2021 ◽  
Vol 3 (3) ◽  
pp. 01-05
Author(s):  
Yasser Mohammed Hassanain Elsayed
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Artery Spasm ◽  
Coronary Spasm ◽  
Electrocardiographic Change ◽  
St Segment ◽  
Patient Concerns ◽  
Calcium Injection

Rationale: Tetany is a common, serious, well-established endocrinal and metabolic hypocalcemic disorder. Chest tetany is a novel metabolic term in hypocalcemia characterized by acute severe twisting chest pain. Movable phenomenon (Yasser’s phenomenon) is a new phenomenon that is usually associated with hypocalcemia. oxygenation may have a role in the management of coronary artery spasm. Patient concerns: A middle-aged farmer smoker male patient presented to physician outpatient clinic with tetany, mimic high lateral myocardial infarction, mirror electrocardiographic change, Movable phenomenon (Yasser’s phenomenon), and coronary artery spasm. Diagnosis: Mimic high lateral myocardial infarction in chest tetany with mirror electrocardiographic change, Movable phenomenon (Yasser’s phenomenon), and coronary artery spasm. Interventions: Electrocardiography, oxygenation, IV calcium injection, and echocardiography. Outcomes: Acute dramatic clinical and electrocardiographic improvement had happened. Lessons: The reversal of mirror electrocardiographic change, reversal of ST-segment depression coronary artery spasm, and normalization of Movable phenomenon (Yasser’s phenomenon) after oxygenation. It signifies the role of oxygen in both coronary artery spasm and tetany. Mirror local electrocardiographic change is a novel described expression that may reflect the myocardial polarity in this chest tetany.

Trigeminocardiac reflex during surgery in the cerebellopontine angle

1999 ◽  
Vol 90 (2) ◽  
pp. 215-220 ◽  
Author(s):  
Bernhard Schaller ◽  
Rudolf Probst ◽  
Stephan Strebel ◽  
Otmar Gratzl
Keyword(s):  
Trigeminal Nerve ◽  
Cerebellopontine Angle ◽  
Experimental Studies ◽  
Ocular Surgery ◽  
Content Type ◽  
Trigeminocardiac Reflex ◽  
Arterial Blood ◽  
Nerve System ◽  
Fine Print ◽  
Stimulation Of

Object. In different experimental studies authors have analyzed the autonomic responses elicited by the electrical, mechanical, or chemical stimulation of the trigeminal nerve system. The trigeminocardiac reflex (TCR) is a well-recognized phenomenon that consists of bradycardia, arterial hypotension, apnea, and gastric hypermotility. It occurs during ocular surgery and during other manipulations in and around the orbit. Thus far, it has not been shown that central stimulation of the trigeminal nerve can also cause this reflex.Methods. The TCR was defined as clinical hypotension with a drop in mean arterial blood pressure (MABP) of more than 20% and bradycardia lower than 60 beats/minute. Pre-, intra-, and postoperative heart rate (HR) and MABP were reviewed retrospectively in 125 patients who underwent surgery for tumors of the cerebellopontine angle (CPA), and they were divided into two groups on the basis of the occurrence of the TCR during surgery. Of the 125 patients, 14 (11%) showed evidence of the TCR during dissection of the tumor near the trigeminal nerve at the brainstem. Their HRs fell 38% and their MABPs fell 48% during operative procedures as compared with preoperative levels. After cessation of manipulation, the HRs and the MABPs returned to preoperative levels. Risk factors for the occurrence of the TCR were compared with results from the literature.Conclusions. The authors' results show the possibility of occurrence of a TCR during manipulation of the central part of the trigeminal nerve when performing surgery in the CPA.

scholarly journals Evaluation of a Novel Three-Dimensional Robotic Digital Microscope (Aeos) in Neurosurgery

Cancers ◽  
2021 ◽  
Vol 13 (17) ◽  
pp. 4273
Author(s):  
Stefanie Maurer ◽  
Vincent Prinz ◽  
Lina-Elisabeth Qasem ◽  
Kristin Elizabeth Lucia ◽  
Judith Rösler ◽  
...  
Keyword(s):  
Case Reports ◽  
Intraoperative Complications ◽  
Three Dimensional ◽  
Depth Of Field ◽  
Daily Routine ◽  
Neurosurgical Procedures ◽  
The Novel ◽  
Surgical Ergonomics ◽  
Digital Microscope

Objective: Current literature debates the role of newly developed three-dimensional (3D) Exoscopes in the daily routine of neurosurgical practice. So far, only a small number of cadaver lab studies or case reports have examined the novel Aesculap Aeos Three-Dimensional Robotic Digital Microscope. This study aims to evaluate the grade of satisfaction and intraoperative handling of this novel system in neurosurgery. Methods: Nineteen neurosurgical procedures (12 cranial, 6 spinal and 1 peripheral nerve) performed over 9 weeks using the Aeos were analyzed. Ten neurosurgeons of varying levels of training were included after undergoing device instruction and training. Following every surgery, a questionnaire consisting of 43 items concerning intraoperative handling was completed. The questionnaires were analyzed using descriptive statistics. Results: No intraoperative complications occurred. Surgical satisfaction was ranked high (78.95%). In total, 84.21% evaluated surgical ergonomics as satisfactory, while 78.95% of the surgeons would like to use this system frequently. Image quality, independent working zoom function and depth of field were perceived as suboptimal by several neurosurgeons. Conclusion: The use of Aeos is feasible and safe in microsurgical procedures, and surgical satisfaction was ranked high among most neurosurgeons in our study. The system might offer advanced ergonomic conditions in comparison to conventional ocular-based microscopes.

scholarly journals Asystole during onyx embolisation of a dural AV fistula: The trigeminocardiac reflex

2018 ◽  
Vol 25 (2) ◽  
pp. 132-134 ◽  
Author(s):  
Patrick Nicholson ◽  
Christopher Hilditch ◽  
Waleed Brinjikji ◽  
Timo Krings
Keyword(s):  
Skull Base ◽  
Arteriovenous Fistula ◽  
Male Patient ◽  
Patient Experience ◽  
Dural Arteriovenous Fistula ◽  
Case Reports ◽  
Neurosurgical Procedures ◽  
Av Fistula ◽  
Trigeminocardiac Reflex ◽  
Onyx Embolisation

There are fewer than 20 published case reports of bradycardia or asystole during intracranial embolisation procedures. These are well described in open neurosurgical procedures, particularly involving the skull base. We present a case of a 59-year-old male patient who presented for elective embolisation of a dural arteriovenous fistula. During the injection of Onyx, the patient experience sudden asystole, which recurred after a second Onyx injection. Following successful treatment, a third injection proceeded without incident.

Calculation-and-experimental estimation of the role of the frequency ratio in changing the endurance at two-frequency deformation modes

2019 ◽  
Vol 85 (1(I)) ◽  
pp. 64-71 ◽  
Author(s):  
M. M. Gadenin
Keyword(s):  
High Frequency ◽  
Experimental Studies ◽  
Low Frequency ◽  
Reduction Factor ◽  
Single Frequency ◽  
Cyclic Loads ◽  
Small Ratio ◽  
Harmonic Components ◽  
Deformation Modes

The cycle configuration at two-frequency loading regimes depends on the number of parameters including the absolute values of the frequencies and amplitudes of the low-frequency and high-frequency loads added during this mode, the ratio of their frequencies and amplitudes, as well as the phase shift between these harmonic components, the latter having a significant effect only with a small ratio of frequencies. Presence of such two-frequency regimes or service loading conditions for parts of machines and structures schematized by them can significantly reduce their endurance. Using the results of experimental studies of changes in the endurance of a two-frequency loading of specimens of cyclically stable, cyclically softened and cyclically hardened steels under rigid conditions we have shown that decrease in the endurance under the aforementioned conditions depends on the ratio of frequencies and amplitudes of operation low-frequency low-cycle and high-frequency vibration stresses, and, moreover, the higher the level of the ratios of amplitudes and frequencies of those stacked harmonic processes of loading the greater the effect. It is shown that estimation of such a decrease in the endurance compared to a single frequency loading equal in the total stress (strains) amplitudes can be carried out using an exponential expression coupling those endurances through a parameter (reduction factor) containing the ratio of frequencies and amplitudes of operation cyclic loads and characteristic of the material. The reduction is illustrated by a set of calculation-experimental curves on the corresponding diagrams for each of the considered types of materials and compared with the experimental data.

Helping when desire is low: The role of Expectancy in helping

2020 ◽  
Author(s):  
Małgorzata Kossowska
Keyword(s):  
Experimental Studies ◽  
Helping Behavior ◽  
Perceived Effectiveness ◽  
Do So

One might assume that the desire to help (here described as Want) is the essential driver of helping declarations and/or behaviors. However, even if desire to help is low, helping behavior may still occur if the expectancy regarding the perceived effectiveness of helping is high. We tested these predictions in a set of three experimental studies. In all three, we measured the desire to help (Want) and the Expectancy that the aid would be impactful for the victim; in addition, we manipulated Expectancy in Study 3. In Studies 1 and 3, we measured the participants’ declaration to help while in Study 2, their helping behavior was examined. In all three studies, we used variations of the same story about a victim. The results supported our hypothesis. Thus, the studies help to tease apart the determinants of helping behavior under conditions of lowered desire to do so, an issue of great importance in public policymaking.

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