Gungor Semih, Aiyer Rohit
Division of Pain Medicine, Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery-Weill Cornell Medicine, Cornell University Department of Psychiatry, Hofstra Northwell Health-Staten Island University Hospital, Staten Island, New York.
Medicine (Baltimore). 2018 Jun;97(26):e11301. doi: 10.1097/MD.0000000000011301.
To present an unusual extrapyramidal motor response occurring after a sympathetic block in CRPS and its successful treatment with diphenhydramine.
Severe pain related to Complex Regional Pain Syndrome type 1 interfering with activities of daily living.
Complex Regional Pain Syndrome type 1.
We report a video case reports of two patients with a diagnosis of CRPS type-I. Both patients exhibited similar presentation of unusual extrapyramidal motor response of the affected limb following lumbar sympathetic block. Both patients were treated with intravenous diphenhydramine to abort the extrapyramidal motor response.
Both patients similarly responded to treatment with intravenous diphenhydramine with abrupt resolution of the motor response.
Sympathetic blockade may interfere with the adaptive autonomic reflex circuits of the motor balance homeostasis in patients with complex regional pain syndrome. Disinhibition of extrapyramidal system may lead to immediate expression of extrapyramidal signs following the sympathetic block. Diphenhydramine, with its anti-histaminic and anticholinergic properties, may be effective in aborting such extrapyramidal signs, and should be considered as a treatment option in similar cases.
呈现复杂性区域疼痛综合征（CRPS）患者交感神经阻滞后出现的一种不寻常的锥体外系运动反应，以及用苯海拉明成功治疗该反应的情况。
与1型复杂性区域疼痛综合征相关的严重疼痛，干扰日常生活活动。
1型复杂性区域疼痛综合征。
我们报告了两例诊断为I型CRPS患者的视频病例报告。两名患者在腰交感神经阻滞后，患侧肢体均表现出类似的不寻常锥体外系运动反应。两名患者均接受静脉注射苯海拉明治疗，以消除锥体外系运动反应。
两名患者对静脉注射苯海拉明治疗的反应相似，运动反应迅速消失。
交感神经阻滞可能会干扰复杂性区域疼痛综合征患者运动平衡稳态的适应性自主反射回路。锥体外系的去抑制可能导致交感神经阻滞后立即出现锥体外系体征。苯海拉明具有抗组胺和抗胆碱能特性，可能有效地消除此类锥体外系体征，在类似病例中应考虑将其作为一种治疗选择。
