ECT in a Patient With Cerebral Aneurysm, Normal Pressure Hydrocephalus With Ventriculoperitoneal Shunt, and Severe Acquired Pyloric Stenosis: Case Report in JECT

 Out on PubMed, in JECT, from authors in Germany, is this case report:

Electroconvulsive Therapy in a Patient With Cerebral Aneurysm, Normal Pressure Hydrocephalus With Ventriculoperitoneal Shunt, and Severe Acquired Pyloric Stenosis.

Jacob T, Grözinger M, Papenfuß T, Mai M, Gahr M.J ECT. 2024 Aug 26. doi: 10.1097/YCT.0000000000001070. Online ahead of print.PMID: 39185885
The abstract is copied below:
Cerebral aneurysm (CA), normal pressure hydrocephalus (NPH) with ventriculoperitoneal shunt (VPS), and pyloric stenosis increase the risk of complications related to electroconvulsive therapy (ECT). Whereas there is some evidence for the safety of ECT in patients with CA and NPH with VPS, there is none in patients with pyloric stenosis that increases the risk of aspiration during short anesthesia. A 67-year-old female patient with a small and stable aneurysm of the right anterior cerebral artery, NPH with VPS, and severe pyloric stenosis (as a result of suicidal ingestion of pipe cleaner) suffering from therapy-resistant depression and chronic suicidal tendencies was treated successfully with 15 sessions of ECT. The following measures were taken to increase ECT-related safety and may help physicians in their decision-making process in similar cases: careful risk assessment based on presentation and discussion of the case in an academic multidisciplinary neurovascular team, glycerol trinitrate sublingual spray before short anesthesia and (after development of hypotension) switching to a pro re nata (PRN) medication with urapidil directly after electric stimulation in case of a relevant increase in blood pressure, examination of the VPS after five stimulations, oral administration of 30 mL of sodium citrate (0.3 molar) before ECT to increase the gastric pH, and establishment of a specific diet and fasting plan (generally only liquid oral food, discontinuation of oral food intake 20 hours, and administration of water only 14 hours before ECT).

The case report is here:





Here is a very interesting case report of a woman with TRD, pyloric stenosis and multiple neurological conditions. Careful pretreatment assessment allowed her to be successfully and safely treated.
We have discussed the issue of incidental cerebral aneurysms before; it is likely that many patients with unknown cerebral aneurysms have, and continue, to get ECT safely.
Kudos to our German colleagues for sharing this complex clinical scenario.

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