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Images in Neurology |

Bradycardia After Coiling of Giant Vertebral Aneurysm

Berend Feddersen, MD; Andreas Straube, MD; Thomas E. Mayer, MD
Arch Neurol. 2006;63(10):1496. doi:10.1001/archneur.63.10.1496.
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A 53-year-old woman with a history of arterial hypertension and subarachnoid hemorrhage in 1998 underwent a second attempt to coil the fusiform giant aneurysm in the intracranial part of the right vertebral artery. Coiling of the partially thrombosed aneurysm was successful. However, self-limiting asystole occurred for 10 seconds during placement of the last coil. In the first 4 days after coiling, the patient had drug-resistant vomiting accompanied by bradycardia, with heart rate as low as 25/min, most probably owing to the direct pressure of the space-occupying aneurysm on the vagus nerve or its nucleus (Figure). There was no sign of embolism, and the neurologic examination, especially of the cranial nerves, yielded normal findings. This symptom required no further medical treatment, and the patient made a full recovery.

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Figure.

Sagittal T1 (A) and axial T2 (B) sections at postinterventional magnetic resonance imaging reveal brainstem compression (arrowheads) by the coiled aneurysm (arrows).

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