Clinical Autonomic Research

, Volume 29, Issue 2, pp 253–254 | Cite as

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...


Stroke Trigeminal cardiac reflex Complications of stroke Stroke recovery 


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.



Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.


  1. 1.
    Burfield L, Ahmad F, Adams J (2016) Glossopharyngeal neuralgia associated with cardiac syncope. BMJ Case Rep. CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Schaller B, Probst R, Strebel S, Gratzl O (1999) Trigeminocardiac reflex during surgery in the cerebellopontine angle. J Neurosurg 90:215–220CrossRefPubMedGoogle Scholar
  3. 3.
    Meuwly C, Golanov E, Chowdhury T, Erne P, Schaller B (2015) Trigeminal cardiac reflex: new thinking model about the definition based on a literature review. In: Patanè S (ed) Medicine, vol 94, no 5. p e484.
  4. 4.
    Singh GP, Chowdhury T, Bindu B, Schaller B (2016) Sudden infant death syndrome—role of trigeminocardiac reflex: a review. Front Neurol 7:221. CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Chowdhury T, Bindu B, Singh GP, Schaller B (2017) Sleep disorders: is the trigemino-cardiac reflex a missing link? Front Neurol 8:63. CrossRefPubMedPubMedCentralGoogle Scholar

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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