2016 年 39 巻 2 号 p. 135-138
Paroxysmal sympathetic hyperactivity (PSH) is a form of autonomic instability, following acute neurological insults, such as severe traumatic brain injury. PSH is characterized by intermittent agitation, diaphoresis, hyperthermia, hypertension, tachycardia, or tachypnea, accompanied by hypertonic movement. We treated a 13-year-old girl who suffered from autonomic instability, associated with elbow flexion of both arms, two months after a traffic accident. Her conscious was disturbed and she did not respond to verbal commands. Magnetic resonance imaging showed diffuse axonal injury signs in the basal ganglia. Ictal body temperature was >39ﾟC, with prominent sweating on the forehead. Physical and laboratory examination revealed no abnormalities besides elevated creatine kinase levels. These episodes lasted approximately a few minutes twice a day. Given the extreme episodes and background, PSH was suspected. However, conventional therapy with antipyretic, anti-convulsants, and sedatives was ineffective. Oral baclofen was not effective. The severe spasticity in both arms prevented full rehabilitation, and she was transferred to our hospital. Following lumbar intrathecal baclofen therapy (ITB), autonomic instability resolved, and she appeared to be more comfortable. A pump was implanted for continuous ITB, and good recovery was seen after the procedure. The patient was transferred to a rehabilitation hospital. Comatose status was gradually relieved. ITB appears to offer a useful therapeutic option for intractable PSH with severe spasticity.
