Lehnerer Sophie Mirabell, Scheibe Franziska, Buchert Ralph, Kliesch Stefan, Meisel Andreas
Department of Experimental Neurology, NeuroCure Clinical Research Center, and Department of Neurology, Charite´-University Medicine Berlin, Berlin, Germany.
Department of Nuclear Medicine, Charite´-University Medicine Berlin, Berlin, Germany.
BMJ Case Rep. 2017 Jul 24;2017:bcr-2017-220305. doi: 10.1136/bcr-2017-220305.
We report the case of a 36-year-old woman with a subarachnoid haemorrhage (SAH) caused by a rupture of a right-sided middle cerebral artery aneurysm and subsequent malignant infarction of the right hemisphere leading to a persistent vegetative state and severe spastic tetraparesis with recurrent myocloni. Nine months after disease onset, the patient was transferred to our department for diagnostic and therapeutic re-evaluation. The poor clinical condition could not be explained by the brain lesion caused by the SAH or infarction. Moreover, glucose metabolism was normal in brain regions not affected by SAH and infarction as shown by positron emission tomography with F-fluorodeoxyglucose. We terminated baclofen and reduced antiepileptics known to impair vigilance and cognitive functions. However, only after starting amantadine treatment we observed a stunning awakening of the patient fully orientated within days. Our findings warrant trials to investigate amantadine in the treatment of unresponsive wakefulness syndromes due to acute central nervous system diseases.
我们报告了一例36岁女性病例，该患者因右侧大脑中动脉瘤破裂导致蛛网膜下腔出血（SAH），随后右半球发生恶性梗死，导致持续植物状态和严重痉挛性四肢瘫并伴有反复肌阵挛。发病九个月后，患者被转至我科进行诊断和治疗再评估。其不佳的临床状况无法用SAH或梗死所致的脑损伤来解释。此外，正电子发射断层扫描显示，未受SAH和梗死影响的脑区葡萄糖代谢正常。我们停用了巴氯芬，并减少了已知会损害警觉性和认知功能的抗癫痫药物。然而，直到开始使用金刚烷胺治疗后，我们才观察到患者在数天内完全清醒且定向力恢复，令人震惊。我们的研究结果值得开展试验，以研究金刚烷胺在治疗急性中枢神经系统疾病所致无反应性觉醒综合征中的作用。
