Cerebellar Hemorrhage Presented as Torsades de Pointes

Kuo-Cheng Wang ； Shou-Yen Chen

《童綜合醫學雜誌》 16卷1期 (2022/06) Pp. 34-36

https://doi.org/10.53106/207135922022061601007

摘要

A 67-year-old female with a history of hypertension was presented to the emergency department with headache and vomiting. She fell into a coma soon after her arrival and had a cardiac arrest. Cardiopulmonary resuscitation was immediately performed, and epinephrine was given every 3 min. Her initial rhythm was pulseless electrical activity, which later developed into Torsades de Pointes (TdP). However, TdP was misinterpreted as ventricular fibrillation (VF). Amiodarone was given for sustained wide QRS complex arrhythmia. After the return of spontaneous circulation (ROSC), a brain computed tomography scan showed a cerebellar haemorrhage. It may be difficult to distinguish TdP from VF during resuscitation since electrocardiographic artefacts could mislead health care providers. In this case, TdP may be related to catecholamine-induced cardiac injury, brain stem compression or adrenergic effects of epinephrine. Furthermore, this case report emphasises the importance of brain computed tomography for patients who suddenly collapsed in emergency departments; even a lethal arrhythmia was initially noted.

關鍵字

cerebellar hemorrhage ； Torsades de Pointes ； cardiac arrest ； ventricular fibrillation