PT  - JOURNAL ARTICLE
AU  - A K J Mandal
AU  - S Baltsezak
AU  - C G Missouris
TI  - Intracerebral haematoma masquerading as ventricular standstill
AID  - 10.1136/hrt.2004.046318
DP  - 2005 Jan 01
TA  - Heart
PG  - e1--e1
VI  - 91
IP  - 1
4099  - http://heart.bmj.com/content/91/1/e1.short
4100  - http://heart.bmj.com/content/91/1/e1.full
SO  - Heart2005 Jan 01; 91
AB  - An 82 year old man was referred to the emergency room by his general practitioner for a right frontoparietal headache. The preceding day he had tripped and fallen, hitting the back of his head on the floor. Computed tomography showed a cortical contre coup haematoma. In view of ventricular standstill noted on ECG, a temporary pacing wire was inserted and a dual chamber permanent pacemaker was subsequently implanted. Intracerebral bleeding was treated conservatively and the patient made a good recovery. All patients admitted with head injury and sinus bradycardia or sinus arrest should be nursed at 15° to 30° with instructions to avoid the head up and supine positions. Furthermore, brain CT should be promptly recorded to assess for intracerebral haematoma and raised intracranial pressure and, if they are confirmed, these patients with cardiovascular compromise should benefit from close collaboration between neurosurgeon and cardiologist. Urgent pacing should be considered for all patients with head injury who experience symptomatic bradycardia or ventricular standstill.