Anesthetic Implications in Alternating Hemiplegia of Childhood: A Case Report-Anesthetic Implications in Alternating Hemiplegia of Childhood: A Case Report

Anesthetic Implications in Alternating Hemiplegia of Childhood: A Case Report

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The case report discusses a 13-year-old patient with Alternating Hemiplegia of Childhood (AHC) who underwent MRI with general anesthesia, resulting in a hemiplegic spell, seizure, apnea, and sudden cardiac arrest, which was successfully managed with resuscitation. AHC is a rare neurodevelopmental disorder characterized by repeated episodes of paralysis, dystonia, seizures, and autonomic dysfunction. Due to the rarity of AHC, there is limited literature on anesthetic management for these patients.<br /><br />The patient in the case had an ATP1A3 gene variant, predisposing him to various neurological and cardiac complications, including arrhythmias. Throughout his medical history, the patient experienced developmental delays, seizures, and occasional psychosis, managed with medications like flunarizine and melatonin. During the procedure, he was anesthetized using sevoflurane, which is known for its minimal airway irritation properties but may exacerbate epileptic patterns. Post-procedure, the patient experienced significant complications, including bradycardia and a subsequent cardiac arrest, managed with medication and resuscitation efforts, leading to a full recovery.<br /><br />The report highlights the need for careful anesthetic planning, considering the risks of seizures, apnea, cardiac arrhythmias, and hemiplegic spells in AHC patients. It emphasizes minimizing environmental triggers in the perianesthetic environment to prevent hemiplegic attacks and choosing anesthetics judiciously given the potential for complications. Notably, the report underscores the lack of extensive research on anesthetic management for children with AHC and calls for more study into how different genetic profiles within AHC might affect anesthesia risks. This case is pioneering in emphasizing the potential cardiac risks in pediatric AHC patients during anesthesia, shedding light on the complex perioperative challenges they present.

Keywords

Alternating Hemiplegia of Childhood

general anesthesia

cardiac arrhythmias

seizure management

ATP1A3 gene

bradycardia

mitochondrial dysfunction

anesthetic risks

dexmedetomidine

resuscitation

AHC

anesthetic management

ATP1A3 gene variant

seizures

cardiac arrest

neurodevelopmental disorder

perioperative challenges

anesthesia risks

pediatric neurology