Neurogenic stunned myocardium: An unusual postoperative complication

OBJECTIVE: In this report of myocardial dysfunction in a pediatric patient after a neurosurgical procedure, we highlight the need for high clinical suspicion for neurogenic stunned myocardium. DESIGN: Case report. SETTING: A tertiary pediatric intensive care unit. PATIENT: A 7-yr-old boy with a history of Chiari malformation type 1, undergoing his fourth surgical procedure, who developed signs of myocardial infarction in the immediate postoperative period. INTERVENTIONS: Serial echocardiograms, a rest-stress myocardial perfusion study, and coronary angiography were performed. Serial troponins were followed. RESULTS: The troponin level normalized 6 days after the initial event, and he was discharged home on a limited course of lisinopril, propanolol, and aspirin and without signs or symptoms of cardiac dysfunction. CONCLUSIONS: Neurogenic stunned myocardium is an uncommon event after neurosurgical procedures in children. Pediatric intensivists need to consider this diagnosis in a patient with signs of myocardial dysfunction in the neurosurgical postoperative period. The management of neurogenic stunned myocardium involves close monitoring and establishing the absence of other causes of myocardial ischemia.