Ghignone Erica, Rosenthal Lisa, Lloyd Robert Brett, Mouli Samdeep, Dinwiddie Stephen
From the Departments of *Psychiatry and Behavioral Sciences, and †Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
J ECT. 2015 Mar;31(1):e14-6. doi: 10.1097/YCT.0000000000000151.
We report on a 30-year-old woman diagnosed with moyamoya syndrome resulting from sickle cell disease who developed catatonia and was successfully treated with electroconvulsive therapy (ECT). Neuroimaging revealed severe tandem narrowing of the left internal carotid artery with diminished cerebral blood flow, moderate narrowing of the right supraclinoid aspect of the right internal carotid artery, and associated numerous lenticulostriate collaterals bilaterally, consistent with moyamoya. The patient presented with mutism; posturing; immobility; stupor; withdrawal; refusal to eat, drink, or speak; and staring, supporting a diagnosis of catatonia. It initially responded to a lorazepam challenge; however, a complicated hospital course and deterioration of the patient's condition, including septic shock, delirium, and continued catatonic symptoms, led to the pursuit of ECT to treat her symptoms. We discuss the risks involved with the administration of ECT in a patient with fragile cerebral vasculature and the successful treatment of catatonia in this patient without resultant stroke or cerebral hemorrhage.
我们报告了一名30岁女性，她被诊断患有镰状细胞病导致的烟雾病综合征，出现了紧张症，并通过电休克疗法（ECT）成功治愈。神经影像学检查显示，左颈内动脉严重串联狭窄，脑血流量减少，右颈内动脉鞍上部分中度狭窄，双侧伴有大量豆纹状侧支循环，符合烟雾病表现。患者表现为缄默、姿势异常、不动、木僵、退缩、拒绝进食、饮水或说话以及凝视，支持紧张症的诊断。最初对劳拉西泮激发试验有反应；然而，复杂的住院过程以及患者病情恶化，包括感染性休克、谵妄和持续的紧张症症状，促使采用ECT来治疗她的症状。我们讨论了在脑血管脆弱的患者中进行ECT治疗所涉及的风险，以及该患者紧张症的成功治疗，且未导致中风或脑出血。
