Beta blocker diabetes contraindicated
Wake Forest Baptist Medical Center Summary: Bradycardia -- a slower than normal heartbeat -- does not increase the risk of developing cardiovascular disease, according to a study. The heart usually beats between 60 and times a minute in an adult at rest. But with bradycardia, the heart beats fewer than 50 times a minute. The condition can cause light-headedness, shortness of breath, fainting or chest pain due to the heart not pumping enough oxygen-rich blood through the body.
We describe the case of beta blocker diabetes contraindicated patient with a ruptured aneurysm on the distal segment of the middle cerebral artery, with a concomitant subdural and intracerebral haemorrhage, and a subsequent secondary brainstem Duret haemorrhage. The year-old woman had hypertension and diabetes in her medical history.
She experienced anomic aphasia and left-sided headache starting one day before admission. She had no trauma.
A few minutes after admission she suddenly became comatose, her breathing became superficial. Non-contrast CT revealed left sided fronto-parietal subdural and subarachnoid and intracerebral haemorrhage, and bleeding was also observed in the right pontine region.
The patient had leucocytosis and hyperglycemia but normal hemostasis. After the subdural haemorrhage had been evacuated, the patient was transferred to intensive care unit. Sepsis developed.
Beta Blockers and Asthma/COPD
Echocardiography did not detect endocarditis. Neurological status, vigilance gradually improved.
The rehabilitation process was interrupted by epileptic status. Control CT and CT angiography proved an aneurysm in the peripheral part of the left middle cerebral artery, which was later clipped.
The brain stem haemorrhage — Duret bleeding — was presumably caused by a sudden increase in intracranial pressure due to the supratentorial space occupying process and consequential trans-tentorial herniation. This case is a rarity, as the patient not only survived, but lives an active life with some residual symptoms.