Ishikawa Rie, Ishikawa Yuhei, Kubota Takeshi, Shirahama Kumi
Department of Anesthesia and Pain Medicine, Hachinohe Heiwa Hospital, 4-6 Minatotakadai 2-chome, Hachinohe, 031-8545, Japan.
Department of Ophthalmology, Hachinohe Heiwa Hospital, 4-6 Minatotakadai 2-chome, Hachinohe, 031-8545, Japan.
JA Clin Rep. 2018 Jul 31;4(1):58. doi: 10.1186/s40981-018-0193-y.
Corticosteroid therapy is useful for the resolution of pain and paresis in Tolosa-Hunt syndrome; however, there is no definitive protocol for appropriate dosing, route of administration, or duration of therapy. Steroid psychosis is an adverse reaction to corticosteroid therapy; in severe cases, it can develop into psychiatric disorders such as delirium, depression, and mania. In this case study, we report a patient with Tolosa-Hunt syndrome who developed delirium while receiving corticosteroid therapy.
The patient was a 70-year-old man being treated for a main complaint of pain in the right eye accompanied by oculomotor paralysis. We suspected Tolosa-Hunt syndrome based on diagnostic imaging and other findings. Steroid pulse therapy was initiated with intravenous methylprednisolone at 1000 mg/day for 3 days, followed by oral prednisolone at 60 mg/day. The pain in the right eye disappeared the day after starting this regimen, and palpebral ptosis also improved. However, 5 days after starting treatment, the patient developed progressively worsening delirium, which was considered an adverse reaction to the steroid pulse therapy. Then, prednisolone treatment was temporarily suspended, and the delirium subsequently disappeared.
The manifestation of steroid psychosis following corticosteroid therapy is dose dependent. Therefore, corticosteroid therapy for elderly patients requires caution and dose modulation because of likely adverse drug reactions.
皮质类固醇疗法有助于缓解托洛萨-亨特综合征的疼痛和轻瘫；然而，对于合适的剂量、给药途径或治疗持续时间，尚无明确的方案。类固醇精神病是皮质类固醇疗法的一种不良反应；在严重情况下，它可发展为精神障碍，如谵妄、抑郁和躁狂。在本病例研究中，我们报告了一名患有托洛萨-亨特综合征的患者，其在接受皮质类固醇治疗时出现了谵妄。
该患者为一名70岁男性，主要症状为右眼疼痛伴动眼神经麻痹。根据诊断性影像学检查和其他发现，我们怀疑为托洛萨-亨特综合征。开始采用静脉注射甲泼尼龙1000毫克/天，持续3天的类固醇冲击疗法，随后口服泼尼松龙60毫克/天。开始该治疗方案后的第二天，右眼疼痛消失，眼睑下垂也有所改善。然而，治疗开始5天后，患者出现了逐渐加重的谵妄，这被认为是类固醇冲击疗法的不良反应。随后，泼尼松龙治疗暂时中断，谵妄随后消失。
皮质类固醇治疗后类固醇精神病的表现与剂量有关。因此，由于可能出现药物不良反应，老年患者的皮质类固醇治疗需要谨慎并调整剂量。
