A case of intrathecal baclofen for paroxysmal sympathetic hyperactivity caused by lacunar infarction following multiple cerebral strokes

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  • 複数回の脳卒中後にラクナ梗塞の再発を契機に発症したparoxysmal sympathetic hyperactivity にintrathecal baclofen が有効であった1 症例

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Abstract

<p>Paroxysmal sympathetic hyperactivity (PSH) is defined as a paroxysmal and repetitive hyperactivity syndrome of autonomic nervous system. While in the case of transient PSH, symptomatic therapy might be effective, the prognosis was dismal in the continuous case. The PSH is thought to result from autonomic dysfunction related to brain damage involving with the deep brain structures. However, there are few reports of PSH following cerebral stroke. Here, we report a case of continuous PSH due to multiple cerebral strokes treated with intrathecal baclofen (ITB) therapy. Initially, he developed lacunae infarction at the age of 51 and was diagnosed as protein C deficiency. After that, he suffered several cerebral strokes such as putaminal hemorrhage and bilateral lacunae infarction. He remained left hemiplegia and dysarthria as sequelae, however, he had been still living at home. In this time, he was admitted to our hospital with intermittent limb stiffness at the age of 60 years. MRI showed new small cerebral infarction of left corona radiata. On admission, he was able to move his right limbs around. However, he was getting worse during a few days and showed whole body stiffness, high fever, tachycardia, hypertension, tachypnea, and diaphoresis continuously. Therefore, the patient was diagnosed as PSH and treated with ITB for spasticity. Six weeks after ITB therapy, the symptoms of PSH have been dramatically improved as well as the reduction of spasticity. It was suggested that the accumulation of small brain lesions can induce PSH, and ITB might be an effective treatment for PSH.</p>

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