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Chewing-induced asystole: a manifestation of the trigeminal cardiac reflex in stroke recovery

  • Jennifer Castle
  • Kyle Rosenstein
  • Michael R. DobbsEmail author
Letter to the Editor

Dear Editors,

The pathway to recovery from an acute ischemic infarct is unique for each patient. We present a 66-year-old woman with a history of hypertension and chronic obstructive pulmonary disease who suffered an acute right middle cerebral artery ischemic stroke confirmed by brain MRI. Recovery was complicated by brief asystolic events while eating. At presentation, she had a National Institutes of Health Stroke Scale (NIHSS) of 21, representative of left facial droop, left upper and lower extremity hemiparesis and ataxia, severe dysarthria and a reduced level of consciousness. Vital signs showed elevated blood pressure. The workup revealed 50–60% luminal narrowing of the proximal right internal carotid artery.

On the fourth hospital day, a swallow evaluation ruled out dysphagia, and she was provided oral nutrition. While chewing (under direct observation), cardiac telemetry showed bradycardia which progressed to asymptomatic asystole of 4-s duration with notable p-waves. She...

Keywords

Stroke Trigeminal cardiac reflex Complications of stroke Stroke recovery 

Notes

Author contributions

Ms. Castle—Study concept and design. Dr. Rosenstein—acquisition of data. Dr. Dobbs—analysis, interpretation and critical revision of the manuscript for important intellectual content.

Funding

None.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.College of MedicineUniversity of KentuckyLexingtonUSA
  2. 2.Department of Neurology, Associate Dean for Statewide and Clinical InitiativesUniversity of Kentucky College of MedicineLexingtonUSA

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