27821134 Visualization

The patient is a 59 Age - year Age - old Age man Sex diagnosed with PD Disease_disorder at the age Date of Date 49 Date years Date .
Fluctuations Sign_symptom with recurring “off” Other_event states Other_event and peak Detailed_description dose Detailed_description dyskinesias Disease_disorder had severely diminished Lab_value the patient’s quality Diagnostic_procedure of Diagnostic_procedure life Diagnostic_procedure .
Thus, the patient was deemed a candidate for bilateral Detailed_description subthalamic Detailed_description DBS Therapeutic_procedure .
Multidisciplinary Diagnostic_procedure evaluation Diagnostic_procedure with 75 Lab_value % Lab_value positive Lab_value response in the standardized Diagnostic_procedure levodopa Diagnostic_procedure test Diagnostic_procedure , exclusion of cognitive Disease_disorder decline Disease_disorder or psychiatric Disease_disorder comorbitity Disease_disorder , and absence of structural brain Disease_disorder damage Disease_disorder potentially relevant to the lead placement led to the unanimous decision for DBS Therapeutic_procedure placement.
When decision was made to proceed to surgery Therapeutic_procedure the medication Medication consisted of 1112.5 Dosage mg Dosage of levodopa Medication and 150 Dosage mg Dosage of piribedil Medication .
There was no History history History of History orofacial Biological_structure or History cervical Biological_structure dystonia Disease_disorder .
In the “on” Other_event state Other_event the patient was alert Sign_symptom without any signs Sign_symptom of Sign_symptom psychiatric Sign_symptom comorbidity Sign_symptom .
Neuropsychological Diagnostic_procedure testing Diagnostic_procedure was adequate Lab_value .
No cranial Biological_structure nerve Sign_symptom deficits Sign_symptom were found and swallowing Diagnostic_procedure was normal Lab_value .
Gait Diagnostic_procedure and postural Diagnostic_procedure stability Diagnostic_procedure was normal Lab_value with minimal Severity rigidity Sign_symptom in the neck Biological_structure and right Biological_structure arm Biological_structure .
Coordinative Diagnostic_procedure motor Diagnostic_procedure skills Diagnostic_procedure such as rapid pro- and Diagnostic_procedure supination Diagnostic_procedure were restricted Lab_value in the left Biological_structure hand Biological_structure .
Dyskinesias Sign_symptom were evident with moderate Severity impairment Sign_symptom .
In the “off” Other_event state Other_event after the medication Medication was held for 12 Duration h Duration , the patient showed mild Severity dysarthria Sign_symptom and dysphonia Sign_symptom , resting Detailed_description tremor Sign_symptom of the right Biological_structure arm Biological_structure and leg Biological_structure , as well as slight Severity action Detailed_description tremor Sign_symptom in the right Biological_structure hand Biological_structure .
Rigidity Sign_symptom was severe Severity in the neck Biological_structure , marked Severity in the right Biological_structure , and mild Severity on the left Biological_structure side Biological_structure .
Motor Diagnostic_procedure skills Diagnostic_procedure of the hands Biological_structure were markedly impaired Lab_value .
Gait Diagnostic_procedure was slow Lab_value but unaided Lab_value and comprised of by intermittent Frequency freezing Sign_symptom ; there was mild Severity dystonic Sign_symptom posturing Sign_symptom of the right Biological_structure foot Biological_structure .
There were no signs of laryngeal Biological_structure spasms Sign_symptom , however.
On the day Date before Date surgery Therapeutic_procedure , the last dose of dopaminergic Medication medication Medication was administered at 07:00 Time p.m., the bedtime Administration dose Administration of levodopa Medication was held to facilitate intraoperative Diagnostic_procedure testing Diagnostic_procedure .
On the day Date of Date the operation Therapeutic_procedure , the patient underwent placement of the stereotactic Therapeutic_procedure frame Therapeutic_procedure under local Medication anaesthesia Medication around 09:00 Time a.m.
After planning standard STN coordinates and trajectories, the patient was placed in a semi Activity - sitting Activity position Activity on the O.R. Nonbiological_location
table, with the frame attached to the table.
At the patient’s request, the head Biological_structure was slightly flexed Activity anteriorly Detailed_description for comfort.
The left Detailed_description electrode Therapeutic_procedure was placed uneventfully.
When performing the bur Therapeutic_procedure hole Therapeutic_procedure on the right Biological_structure side Biological_structure , the patient complained of cramping Sign_symptom in the neck Biological_structure and facial Biological_structure muscles Biological_structure as well as difficulties Sign_symptom breathing Sign_symptom although at that point, pulse Diagnostic_procedure oximetry Diagnostic_procedure showed good Lab_value saturation Lab_value readings at ≥95 Lab_value % Lab_value .
He progressed to dystonic Sign_symptom dysarthria Sign_symptom [6].
Microelectrode Diagnostic_procedure recordings Diagnostic_procedure had already been done and macroelectrode Diagnostic_procedure test Diagnostic_procedure stimulation Diagnostic_procedure was about to begin, when the patient showed high Detailed_description - pitched Detailed_description inspiratory Detailed_description stridor Sign_symptom .
Pulse Diagnostic_procedure oximetry Diagnostic_procedure showed decreasing Lab_value oxygen Lab_value saturation Lab_value at 02:15 Time p.m.
and, shortly thereafter, narrow Detailed_description complex Detailed_description tachycardia Sign_symptom was noted.
Within Time a Time minute Time , the patient became unresponsive Sign_symptom .
Cardiac Therapeutic_procedure resuscitation Therapeutic_procedure was initiated and the patient was fiberoptically Detailed_description intubated Therapeutic_procedure after removal of the front Therapeutic_procedure bar Therapeutic_procedure of the stereotactic Therapeutic_procedure frame Therapeutic_procedure .
During fiberoptic Detailed_description intubation Therapeutic_procedure laryngeal Biological_structure spasm Sign_symptom was confirmed visually.
A transthoracic Diagnostic_procedure echocardiogram Diagnostic_procedure obtained immediately after successful resuscitation showed no cardiac Biological_structure pathology Sign_symptom or any air Sign_symptom bubbles Sign_symptom .
Stimulation Therapeutic_procedure using the implanted lead to resolve the symptoms was not possible as at that time the lead was subcutaneously tunnelled with no impulse generator attached.
The right Detailed_description permanent Detailed_description electrode Therapeutic_procedure was placed without further testing according to microelectrode Diagnostic_procedure recordings Diagnostic_procedure .
50 Dosage mg Dosage levodopa Medication was administered over a nasogastric Administration tube Administration every Dosage two Dosage hours Dosage during the subsequent postoperative Diagnostic_procedure period Diagnostic_procedure .
Postoperative head Biological_structure CT Diagnostic_procedure scan done immediately after the procedure was normal.
The patient was transferred Clinical_event to the intensive Nonbiological_location care Nonbiological_location unit Nonbiological_location and was extubated Therapeutic_procedure at 02:00 Time p.m.
the following Date day Date without any neurological Sign_symptom deficit Sign_symptom or signs of laryngeal Biological_structure spasms Sign_symptom .
By then, the nasogastric Therapeutic_procedure tube Therapeutic_procedure was discontinued and the preoperative medication Medication was resumed.
Cardiac Diagnostic_procedure workup Diagnostic_procedure was negative Lab_value .
The impulse Therapeutic_procedure generator Therapeutic_procedure was implanted 7 Date days Date later Date and the patient showed good Lab_value symptom Diagnostic_procedure control Diagnostic_procedure of PD Disease_disorder .