Amelioration of cerebellar hemorrhage-associated intractable vomiting by perphenazine: a report of two cases

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  • Arai Motomi
    Department of Neurology, Tenryu Suzukake Hospital Department of Neurology, Seirei Mikatahara General Hospital

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  • ペルフェナジン内服により小脳出血に伴う難治性嘔吐が消失した2 例

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<p>Protracted vomiting in patients with a cerebellar hemorrhage reportedly obstructs rehabilitation and correlates with poorer outcomes. Here, we discuss two cases that highlight the efficacy of perphenazine in treating cerebellar hemorrhage-associated intractable vomiting. Two Japanese males experienced a sudden onset of nausea, vomiting, and unsteady gait. After receiving conservative therapy, they were transferred to our hospital for rehabilitation therapy. In patient 1, a 66-year-old male, the right nodulus and juxtarestiform body were presumably involved in a small hematoma. The patient’s recurrent vomiting was completely resolved with oral perphenazine 12 mg daily and he became able to gait unaided. However, after the 6-week of treatment, he developed akathisia, which completely disappeared after the discontinuation of perphenazine. Patient 2, a 68-year-old male, presented with not only severe truncal ataxia, but also impairment of executive functions and disinhibited sexual behavior, which were consistent with the cerebellar cognitive affective syndrome. Computed tomography revealed a large hematoma in the posterior lobe of the cerebellum principally on the left side. Treatment with an increasing dose of perphenazine (up to 24 mg) completely resolved both persistent vomiting and sexual disinhibition. However, over the next 4 weeks, as he gradually developed Parkinsonism, we tapered off perphenazine. Treatment with levodopa-carbidopa effectively improved akinesia. Approximately 5 months after the onset of stroke, he regained independent gait with a T-cane. Perphenazine is a treatment option for cerebellar hemorrhage-associated intractable vomiting. However, clinicians should be wary of the adverse effects of perphenazine because its chronic administration and high dose tend to cause extrapyramidal side effects.</p>

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