Dislocated Pacemaker Electrode Simulating Focal Epileptic State in a Patient with Subdural Hematoma-Case Report and Review of the Literature

World Neurosurgery
Sae-Yeon WonC Senft

Abstract

Due to demographic changes, the number of patients with traumatic brain injury carrying a cardiac resynchronization therapy device is increasing. One of the common complications of subdural hematoma (SDH) is epilepsy, whereas one of the most frequent early complications after cardiac resynchronization therapy device implantation is lead dislocation. The latter might then cause unintended skeletal muscle stimulation that might be misinterpreted in seizure-prone patients. An 86-year-old female patient with an initially conservatively treated SDH on the right side presented with a tonic muscle contraction in her left arm 2 weeks after the trauma not responding to antiepileptic therapy. A computed tomography scan revealed residual hematoma on the right side with regular, time-dependent resorption. The muscle contraction was misdiagnosed as a focal epileptic state leading to evacuation of the chronic SDH. Additionally, routine postoperative chest radiographs were performed. Postoperatively, the tonic muscle contraction in her arm persisted. Chest radiographs revealed a dislocation of the left ventricular electrode, which appeared retracted into the left subclavian vein, next to the plexus brachialis. After deactivating the electrode...Continue Reading

References

Dec 1, 1989·Journal of Neurosurgery·M A HowardH R Winn
Mar 1, 1972·Progress in Cardiovascular Diseases·B D Kosowsky, I Barr
Jul 1, 1993·Surgical Neurology·N PhuenpathomS Ratanalert
Jan 1, 1998·The New England Journal of Medicine·J F AnnegersW A Rocca
Jan 1, 1997·Neurosurgical Review·R K KoçA Menkü
Jun 29, 2010·Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia·M T ForsterR Gerlach
Oct 30, 2010·Stroke; a Journal of Cerebral Circulation·Ammar MajeedSam Schulman
Feb 23, 2011·Therapeutic Advances in Neurological Disorders·Maja KojovicKailash Bhatia
Nov 3, 2012·The Journal of Trauma and Acute Care Surgery·Christina G RyanJoann G Elmore
Feb 15, 2013·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Pietro PalmisanoStefano Favale
Sep 10, 2013·Clinical Neurology and Neurosurgery·Tadashi HamasakiJun-ichi Kuratsu
Aug 12, 2015·Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia·Henri-Arthur LeroyJean-Paul Lejeune
Sep 25, 2015·Neurocritical Care·Kevin T HuangWilliam B Gormley

Related Concepts

Misdiagnosis
Implantable Stimulation Electrodes
Single Seizure
False Positive Reactions
Artificial Cardiac Pacemaker
Hematoma, Subdural, Intracranial
Antiepileptic Agents
Brachial Plexus Structure
Complication
Differential Diagnosis

Related Feeds

Brain Injury & Trauma

brain injury after impact to the head is due to both immediate mechanical effects and delayed responses of neural tissues.