Kaijima M, Fukuda H, Tomabechi M, Hodozuka A
Department of Neurosurgery, Megumino Hospital.
No Shinkei Geka. 1989 May;17(5):467-71.
Cases involving two patients who presented post-traumatic prolonged disturbance of consciousness (PTPDC), namely akinetic mutism, and recovered from it after treatment with trihexyphenidyl were reported. Case 1: A seventy-one-year-old farmer. Five months after head injury, when he was first admitted to us, he was stable with signs of oligokinesia, katatonic posture, speechlessness, rigid muscle tones and positive cog-wheel phenomenon. One week after administration of the drug, his speech and voluntary movement improved remarkably. Two months after the treatment, he was able to walk, and was discharged from the hospital. Case 2: A forty-six-year-old man sustained major head trauma. In the acute stage, he was comatose with decerebrate posture. On the 15th hospital day, he showed a state of akinetic mutism with normal sleep - wakefulness cycle. Evacuation of the collected subdural fluid was done one month after the injury, which resulted in no change in his clinical state. Five months after the injury, trihexyphenidyl treatment was begun. A few days after the treatment, his motor activity and his facial expression obviously improved. One week after, he mimicked the word 'o-ha-yo (good morning)' after the physician's greeting. CT scan and magnetic resonance imaging in the chronic state of these patients showed bifrontal cerebral white matter lesions, which indicated old cerebral contusion. No brain stem lesions were detected with these examinations. Our two cases clearly did not belong to the category of post-traumatic parkinsonism because of their clinical courses, and their features shown in radiological examinations. However the anti-parkinsonian drug, trihexyphenidyl was effective.(ABSTRACT TRUNCATED AT 250 WORDS)
报告了两例创伤后意识长期障碍（PTPDC），即运动不能性缄默症的患者，经用苯海索治疗后康复。病例1：一名71岁农民。头部受伤5个月后首次入院时，他病情稳定，有运动减少、紧张性姿势、失语、肌肉强直和阳性齿轮现象。用药1周后，他的言语和自主运动明显改善。治疗2个月后，他能够行走并出院。病例2：一名46岁男性遭受严重头部创伤。急性期时，他昏迷并呈去大脑强直姿势。伤后第15天，他表现为运动不能性缄默症状态，睡眠-觉醒周期正常。伤后1个月进行了硬膜下积液引流，其临床状态无变化。伤后5个月开始用苯海索治疗。治疗几天后，他的运动活动和面部表情明显改善。1周后，在医生问候后他模仿说出了“早上好”这个词。这些患者慢性期的CT扫描和磁共振成像显示双侧额叶脑白质病变，提示陈旧性脑挫伤。这些检查未发现脑干病变。由于其临床病程以及影像学检查显示的特征，我们的这两个病例显然不属于创伤后帕金森综合征范畴。然而，抗帕金森药物苯海索是有效的。（摘要截断于250字）
