Unraveling a complete heart block in a post-craniotomy patient: a case report presenting a rare association and review of literature

BackgroundA masquerading complete heart block (CHB) presenting with stroke symptoms is a rare and challenging clinical scenario that requires a thorough diagnostic workup and multidisciplinary approach with appropriate neurological and cardiac interventions. This gets further compounded in a post-craniotomy patient. To the best of our knowledge, this is the first case wherein the CHB was diagnosed in the post-craniotomy scenario which is a potential confounder. We believe that this case will be an educational point for neurosurgeons/physicians to prevent the complications that could potentially happen in an undiagnosed/untreated CHB patient undergoing complex neurosurgeries.Case presentationA 64-year-old male underwent an emergency left suboccipital decompression craniectomy with external ventricular drain placement, for a left cerebellar infarct with fourth ventricle obstruction and brainstem compression. Despite ruling out most probable neurological causes, the bradycardia was persistent. This warranted a Holter monitoring that unmasked the CHB, following which a permanent pacemaker was implanted.ConclusionsAlthough bradycardia is quite common in neurosurgical patients, extreme vigilance is needed to identify the exact cause in some occult cases. Cardiac consultation might be of immense help in such cases to prevent catastrophe especially during the perioperative phase as it is associated with significant hemodynamic disturbances. Ultimately, this will lead to an overall improvement of the neurological outcomes.