{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T13:32:01Z","timestamp":1768311121441,"version":"3.49.0"},"reference-count":15,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2017,6,28]]},"abstract":"<jats:p>We describe a case of reproducible asystole during endovascular treatment of a posterior fossa dural arteriovenous fistula. Catheterisation of the posterior meningeal artery, a branch of the vertebral artery in this patient, followed by dimethyl sulfoxide injection prior to Onyx administration resulted in two episodes of asystole.<\/jats:p><jats:p>To the best of our knowledge, this is the first reported case of asystole occurring during endovascular intervention in the posterior meningeal artery. This may represent a previously undescribed variant of the trigemino-cardiac reflex (TGCR) caused by chemical stimulation of small areas of trigeminally innervated posterior fossa dura. Alternatively, this may represent a newly identified phenomenon with chemical stimulation of regions of posterior fossa dura innervated by branches of the vagus nerve leading to increased parasympathetic activity and resultant asystole.<\/jats:p><jats:p>In either case, it is important to recognise the potential for such episodes in this vascular territory to allow case planning and management.<\/jats:p>","DOI":"10.1136\/bcr-2017-221033","type":"journal-article","created":{"date-parts":[[2017,9,24]],"date-time":"2017-09-24T09:29:39Z","timestamp":1506245379000},"page":"bcr-2017-221033","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Posterior meningeal artery DMSO injection resulting in reproducible asystole prior to Onyx therapy of a dural arteriovenous fistula: a previously undescribed variant of the trigeminocardiac reflex or a new phenomenon?"],"prefix":"10.1136","volume":"2017","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3758-9395","authenticated-orcid":false,"given":"Matthew Thomas","family":"Crockett","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8632-0130","authenticated-orcid":false,"given":"Anthony Ernest","family":"Robinson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harmeet","family":"Aneja","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9023-5986","authenticated-orcid":false,"given":"Timothy John","family":"Phillips","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2017,7,24]]},"reference":[{"key":"2025042712140429000_2017.jul24_1.bcr-2017-221033.1","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1999.90.2.0215"},{"key":"2025042712140429000_2017.jul24_1.bcr-2017-221033.2","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A0675"},{"key":"2025042712140429000_2017.jul24_1.bcr-2017-221033.3","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000000484","article-title":"Trigeminal cardiac reflex: new thinking model about the definition based on a literature review","volume":"94","author":"Meuwly","year":"2015","journal-title":"Medicine"},{"key":"2025042712140429000_2017.jul24_1.bcr-2017-221033.4","doi-asserted-by":"crossref","unstructured":"Tamura T , Rex DE , Marosfoi MG , et al . Trigeminocardiac reflex caused by selective angiography of the middle meningeal artery. BMJ Case Rep 2016:1.doi:10.1136\/bcr-2016-012517","DOI":"10.1136\/bcr-2016-012517"},{"key":"2025042712140429000_2017.jul24_1.bcr-2017-221033.5","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1007\/s00062-014-0362-y","article-title":"Endovascular treatment of Intracranial Dural Arteriovenous Fistulas presenting with Intracranial hemorrhage in 46 Consecutive patients: with emphasis on Transarterial embolization with Onyx","volume":"26","author":"Li","year":"2016","journal-title":"Clin Neuroradiol"},{"key":"2025042712140429000_2017.jul24_1.bcr-2017-221033.6","first-page":"658","article-title":"Trigeminocardiac reflex. A clinical phenomenon or a new physiological entity?","volume":"251","author":"Schaller","year":"2004","journal-title":"J Neurol"},{"key":"2025042712140429000_2017.jul24_1.bcr-2017-221033.7","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1097\/ANA.0b013e3182204c2c","article-title":"Trigeminocardiac reflex during temporary clipping in aneurismal surgery: first description","volume":"23","author":"Spiriev","year":"2011","journal-title":"J Neurosurg Anesthesiol"},{"key":"2025042712140429000_2017.jul24_1.bcr-2017-221033.8","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000005436","article-title":"The negative chronotropic effect during lumbar spine surgery: A systemic review and aggregation of an emerging model of spinal cardiac reflex","volume":"96","author":"Chowdhury","year":"2017","journal-title":"Medicine"},{"key":"2025042712140429000_2017.jul24_1.bcr-2017-221033.9","doi-asserted-by":"publisher","DOI":"10.1177\/1591019916654140"},{"key":"2025042712140429000_2017.jul24_1.bcr-2017-221033.10","doi-asserted-by":"publisher","DOI":"10.1177\/159101991001600107"},{"key":"2025042712140429000_2017.jul24_1.bcr-2017-221033.11","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A0675"},{"key":"2025042712140429000_2017.jul24_1.bcr-2017-221033.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2011.10.045"},{"key":"2025042712140429000_2017.jul24_1.bcr-2017-221033.13","doi-asserted-by":"publisher","DOI":"10.1001\/archneurpsyc.1940.02280070051003"},{"key":"2025042712140429000_2017.jul24_1.bcr-2017-221033.14","doi-asserted-by":"publisher","DOI":"10.1148\/91.2.271"},{"key":"2025042712140429000_2017.jul24_1.bcr-2017-221033.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.surneu.2004.03.022"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2017-221033","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,27]],"date-time":"2025-04-27T19:14:13Z","timestamp":1745781253000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2017-221033"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,7,24]]},"references-count":15,"alternative-id":["10.1136\/bcr-2017-221033"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2017-221033","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,7,24]]}}}