• Ifeanyi Iwuchukwu, Agnieszka Ardelt, Wilson Cueva, Rwoof Reshi, Fernando Goldenberg, and Jeffrey Frank.
• Division of Neurocritical Care, Department of Neurology, Ochsner Medical Center, New Orleans, LA, USA, iiwuchuk@tulane.edu.
• Neurocrit Care. 2014 Feb 1;20(1):106-10.

BackgroundMacroglossia has been reported in patients undergoing posterior fossa neurosurgical procedures and is thought to be as a result of venous engorgement from intubation or mechanical positioning during these prolonged procedures.MethodsWe report three patients who developed macroglossia and dysautonomia of central neurogenic origin following brainstem injury.ResultsThe three patients developed macroglossia and dysautonomia with wide hemodynamic fluctuations in the setting of posterior fossa injury of the lower brainstem structures, necessitating tracheostomy placement. Macroglossia was managed with dexamethasone and there was complete resolution of dysautonomia while treated with beta-blockers and gabapentin.ConclusionsNeurointensivists should be aware of macroglossia with dysautonomia complicating brainstem injury, which may have perilous consequences in the setting of cerebral edema or intracranial hypertension.

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