• Toma Spiriev, Nora Sandu, Belachew Arasho, Slavomir Kondoff, Christo Tzekov, Bernhard Schaller, and Trigemino-Cardiac Reflex Examination Group (TCREG).
• Department of Neurosurgery, Tokuda Hospital, Sofia, Bulgaria. spiriev@gmail.com.
• J Med Case Rep. 2010 Nov 30; 4: 391.

IntroductionThe trigemino-cardiac reflex is defined as the sudden onset of parasympathetic dysrhythmia, sympathetic hypotension, apnea, or gastric hypermotility during stimulation of any of the sensory branches of the trigeminal nerve. Clinically, trigemino-cardiac reflex has been reported to occur during neurosurgical skull-base surgery. Apart from the few clinical reports, the physiological function of this brainstem reflex has not yet been fully explored. Little is known regarding any predisposing factors related to the intraoperative occurrence of this reflex.Case PresentationWe report the case of a 70-year-old Caucasian man who demonstrated a clearly expressed form of trigemino-cardiac reflex with severe bradycardia requiring intervention that was recorded during surgical removal of a large subdural empyema.ConclusionTo the best of our knowledge, this is the first report of an intracranial infection leading to perioperative trigemino-cardiac reflex. We therefore add a new predisposing factor for trigemino-cardiac reflex to the existing literature. Possible mechanisms are discussed in the light of the relevant literature.

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