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Case Reports in Medicine
Volume 2017, Article ID 6301430, 3 pages
https://doi.org/10.1155/2017/6301430
Case Report

Pacemaker Placement in Patients with Stroke-Mediated Autonomic Dysregulation

1Department of Internal Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
2Division of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL 32224, USA
3Department of Neurology, Mayo Clinic, Jacksonville, FL 32224, USA

Correspondence should be addressed to Michael B. Phillips; ude.oyam@2leahcim.spillihp

Received 25 November 2016; Revised 16 February 2017; Accepted 2 March 2017; Published 16 March 2017

Academic Editor: Omer Faruk Dogan

Copyright © 2017 Ali A. Alsaad et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Lateral medullary syndrome (LMS) is an ischemic disease of the medulla oblongata, which involves the territory of the posterior inferior cerebellar artery. Lateral medullary syndrome is often missed as the cause of autonomic dysregulation in patients with recent brain stem stroke. Due to the location of the baroreceptor regulatory center in the lateral medulla oblongata, patients with LMS occasionally have autonomic dysregulation-associated clinical manifestations. We report a case of LMS-associated autonomic dysregulation. The case presented as sinus arrest and syncope, requiring permanent pacemaker placement. A dual-chamber pacemaker was placed, after failure of conservative measures to alleviate the patient’s symptoms. Our case shows the importance of recognizing LMS as a potential cause for life-threatening arrhythmias, heart block, and symptomatic bradycardia. Placement of permanent pacemaker may be necessary in some patients with LMS presenting with syncope, secondary to sinus arrest.