Giménez-Roldán S, Mateo D, Martín M
Department of Neurology, Hospital General Gregorio Marañón, Madrid, Spain.
Mov Disord. 1989;4(4):349-53. doi: 10.1002/mds.870040411.
A 64-year-old woman with blepharospasm, sustained clenching of the jaw, antecollis, and a strained, high-pitched phonation continued chronic trihexyphenidyl therapy despite the lack of any obvious benefit. Abrupt, accidental withdrawal of trihexyphenidyl triggered severe exacerbation of the cranial dystonia associated with inspiratory stridor and acute respiratory difficulties, prompting emergency admission. On indirect laryngoscopy, hyperadduction of the vocal folds was not the cause of the upper airway obstruction. A more likely cause of the inspiratory obstruction appeared to be forward bending of the neck combined with mouth-clenching spasms. Reinstitution of intravenous anticholinergic medication provided relatively prompt relief. We caution against abrupt interruption of anticholinergics in patients with severe segmental cranial dystonia, even in those cases in which no benefit is apparent to observers.
一名64岁女性患有睑痉挛、持续牙关紧闭、颈前屈以及紧张、高音调发声，尽管没有明显益处，仍继续接受慢性苯海索治疗。苯海索突然意外停药引发了与吸气性喘鸣和急性呼吸困难相关的颅肌张力障碍严重加重，促使其紧急入院。间接喉镜检查显示，声带内收过度并非上呼吸道梗阻的原因。吸气性梗阻更可能的原因似乎是颈部前屈合并牙关紧闭痉挛。重新静脉注射抗胆碱能药物后症状相对迅速缓解。我们提醒，对于患有严重节段性颅肌张力障碍的患者，即使在观察者看来没有明显益处的情况下，也应避免突然中断抗胆碱能药物治疗。
