Bilateral Subarachnoid Hemorrhage and bilateral Intracranial Hemorrhage
during Dobutamine Stress Echocardiography
Abstract
Dobutamine stress echocardiogram (DSE) is routinely used in the clinical
assessment of patients with known or suspected coronary artery disease
(CAD). DSE can cause serious complications including cerebrovascular
accident (CVA). Even though, the incidence of CVA associated with DSE is
very low (<0.01%), it can be life-threatening or cause
significant morbidity. We present a patient who also developed acute
multifocal intracranial (ICH) and subarachnoid hemorrhages (SAH) during
the DSE. A 39 years old female, with no prior cardiac history, presented
to the outpatient echocardiography lab for DSE. She had blunted heart
rate response with increasing dose of dobutamine 30 μg/kg/min and was
given one milligram of atropine. The patient complained of frontal
headache, nausea, and severe dyspnea. CT head showed acute multifocal
bilateral SAH, left frontal and right parieto-occipital ICH.
Hypertension is one of the risk factors for ICH and dobutamine infusion
can exacerbate severe acute hypertension, which can cause acute
intraparenchymal hemorrhage. Even though the risk of ICH associated with
DSE is extremely low, there should be increased vigilance if there is
development of severe acute hypertension and the operator should keep a
low threshold for further evaluation if the patient develops
neurological symptoms.