Introduction: The most common hemodynamic change observed during seizures is sympathetic activation.
But dysautonomia associated with seizures leading to hypotension is also a probability
in such situations. Case Summary: We report an unusual manifestation of seizures as significant hypotension in a young
lady who underwent a transcranial decompression of pituitary macroadenoma. The first
episode occurred during the intraoperative period (fall in systolic blood pressure
(BP) from 110 to 30 mm Hg) but the clinical manifestations were masked because of
general anesthesia and muscle relaxation. On the second occasion, a GTCS occurred
in the intensive care unit with concomitant hypotension (systolic BP falling to 40
mm Hg). Both episodes required vasopressor support to restore BP to normal levels.
Conclusion: Acute hypotension unexplainable by other causes can be a manifestation of seizure
during anesthesia for neurosurgery. Hypotension caused by dysautonomia can produce
cerebral hypoperfusion and prolong EEG suppression leading to a vicious cycle. So
rapid identification of seizure as a cause for hypotension and its prompt control,
can avoid further cerebral ischemia during neurosurgeries.
