Article Text

PDF
Case report
Trigeminocardiac reflex caused by selective angiography of the middle meningeal artery
  1. Takamitsu Tamura1,2,
  2. David E Rex1,
  3. Miklos G Marosfoi1,
  4. Ajit S Puri1,
  5. Matthew J Gounis1,
  6. Ajay K Wakhloo1
  1. 1Division of Neuroimaging and Intervention and New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  2. 2Department of Neurosurgery, University of the Ryukyus, Nishihara, Okinawa, Japan
  1. Correspondence to Dr Takamitsu Tamura, Division of Neuroimaging and Intervention and New England Center for Stroke Research, Department of Radiology, University of Massachusettes Medical School, 55 Lake Avenue North, Worcester, MA 01655-0112, USA; Takamitsu.Tamura{at}umassmed.edu

Abstract

We describe an interesting case of trigeminocardiac reflex (TCR) caused by selective angiography of the middle meningeal artery (MMA). A 28-year-old woman presented with a symptomatic meningioma. Preoperative tumour embolisation was performed. In the procedure, when selective MMA angiography was done with Omnipaque 300 mg I/mL for 3 mL by manual injection, the patient complained of flashing lights in her eye followed by vomiting and bradycardia down to 40 bpm without increased intracranial pressure signs. On selective MMA angiography, the choroidal crescent and arteries of the periorbital region were opacified by anastomosis from the MMA via the meningo-ophthalmic artery. We diagnosed that her symptoms were caused by selective MMA angiography leading to high pressure stimulation towards the ophthalmic nerve innervation around the orbit as a TCR. We suggest that the operator should be prepared to manage TCR during treatment with expected selective MMA angiography, and gentle low pressure contrast injection should be attempted.

Statistics from Altmetric.com

Footnotes

  • Republished with permission from BMJ Case Reports Published 5 July 2016; doi:10.1136/bcr-2016-012517

  • Contributors TT, DER, MGM, ASP, MJG and AKW critically reviewed the study proposal.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement We agree with data sharing.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.