肉毒杆菌毒素注射后头部下垂：医源性肉毒中毒的电诊断评估
Head drop after botox: Electrodiagnostic evaluation of iatrogenic botulinum toxicity.
作者信息
Szuch Eliza, Caress James B, Paudyal Bandhu, Brashear Allison, Cartwright Michael S, Strowd Roy E
机构信息
Department of Neurology, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston Salem, NC 27157, USA.
Department of Neurology, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston Salem, NC 27157, USA.
出版信息
Clin Neurol Neurosurg. 2017 May;156:1-3. doi: 10.1016/j.clineuro.2017.02.012. Epub 2017 Mar 6.
BACKGROUND
Botulinum is a potent neurotoxin with increasing indications for neurologic disorders. While clinical benefit manifests primarily due to local actions at the neuromuscular junction, regional and systemic effects do occur. Rarely, systemic symptoms including weakness, dysarthria, dysphagia and other side effects occur as a result of iatrogenic botulinum neurotoxicity.
CASE
A 72 year-old female with right leg dystonia developed head drop, bulbar and systemic weakness following right lower extremity botulinum toxin injection. Routine nerve conduction studies were normal. Repetitive stimulation of the spinal accessory nerve showed decrement; electromyography (EMG) demonstrated slightly small units with subtle signs of denervation, and single fiber EMG revealed increased jitter with blocking, all of which are consistent with systemic botulism.
CONCLUSION
This case highlights and reviews the important electrodiagnostic features of iatrogenic systemic botulinum neurotoxicity.
背景
肉毒杆菌是一种强效神经毒素，其在神经系统疾病中的应用指征不断增加。虽然临床益处主要源于其在神经肌肉接头处的局部作用，但也会出现局部和全身效应。医源性肉毒杆菌神经毒性很少会导致包括肌无力、构音障碍、吞咽困难及其他副作用在内的全身症状。
病例
一名72岁女性，患有右腿肌张力障碍，在右下肢注射肉毒杆菌毒素后出现头部下垂、延髓及全身肌无力。常规神经传导检查正常。对副神经进行重复刺激显示波幅递减；肌电图（EMG）显示运动单位略小，有轻微失神经支配迹象，单纤维肌电图显示颤抖增加并伴有阻滞，所有这些均与全身性肉毒中毒相符。
结论
本病例突出并回顾了医源性全身性肉毒杆菌神经毒性重要的电诊断特征。
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