PDF(Pubmed)
Abstract：
Tachycardia-bradycardia syndrome (TBS) is a variant of sick sinus syndrome (SSS) characterized by alternating tachycardia and bradycardia. A few cases of SSS secondary to structural lesions in the medulla have been reported, but there has never been a reported case of the rare sign akin to TBS following acute non-medullary brainstem infarction. Furthermore, new-onset cardiac arrhythmias in stroke often presented in one continuous pattern - either as bradycardia or tachycardia, but instances of an alternating fashion have been rarely reported. We present the case of a 46-year-old female who developed severe dizziness with vomiting, diplopia, and slurred speech, which gradually worsened to quadriplegia, severe hypophonia, and dysphagia. Brain magnetic resonance imaging (MRI) demonstrated acute midbrain and pontine infarction. Except for neurological symptoms, the patient experienced unexpected TBS with the symptoms of excessive sweating, palpitations, and irritability without any other predisposing factors. The frequency of the episodes gradually declined until it spontaneously disappeared the 5th day after admission. Given the unpredictable nature of the tachycardia and bradycardia, it was challenging to manage the arrythmias with medications. A pacemaker was recommended, but financial reasons led the patient to reject this option. Two weeks after antithrombotic therapy and rehabilitation, she was discharged with residual symptoms of diplopia, moderate dysarthria, mild quadriplegia, and no cardiac symptoms. Our case highlighted the occurrence of TBS as a new-onset arrhythmia that can manifest during the acute phase of non-medullary brainstem infarcts. Further research into brainstem lesions contributing to TBS is warranted us to elucidate the underlying mechanisms.
摘要：
心动过速-心动过缓综合征（TBS）是病态窦房结综合征（SSS）的一种变体，其特征是心动过速和心动过缓交替。已经报道了几例继发于髓质结构性病变的SSS，但从未有报道过急性非髓性脑干梗死后出现类似TBS的罕见体征.此外，中风中新发心律失常通常以一种连续模式出现-心动过缓或心动过速，但是很少报道交替出现的情况。我们介绍一名46岁的女性，她出现严重头晕并呕吐，复视,说话含糊不清，逐渐恶化为四肢瘫痪，严重的低张力,和吞咽困难.脑磁共振成像（MRI）显示急性中脑和脑桥梗死。除了神经症状,患者经历了意外的TBS，表现为出汗过多，心悸,和烦躁，没有任何其他诱发因素。发作的频率逐渐下降，直到入院后第5天自发消失。鉴于心动过速和心动过缓的不可预测性质，用药物来管理心律失常是具有挑战性的。建议安装起搏器,但是经济原因导致患者拒绝了这个选择。抗血栓治疗和康复两周后，她因复视残留症状出院，中度构音障碍,轻度四肢瘫痪,没有心脏症状.我们的病例强调了TBS的发生是一种新发的心律失常，可以在非延髓性脑干梗塞的急性期表现出来。我们有必要进一步研究导致TBS的脑干病变，以阐明其潜在机制。
