Morinaga Yusuke, Nii Kouhei, Hanada Hayatsura, Sakamoto Kimiya, Inoue Ritsurou, Mitsutake Takafumi
Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan.
Intractable Rare Dis Res. 2020 May;9(2):119-122. doi: 10.5582/irdr.2020.01021.
Paroxysmal sympathetic hyperactivity (PSH) is a clinical condition characterized by abnormal paroxysmal surges in sympathetic nervous system activity. PSH is known to occur after severe head injury and hypoxic encephalopathy. Cases of PSH that develop after stroke have been reported worldwide; however, PSH is not commonly reported in the field of stroke research in Japan. Some studies have suggested that gabapentin may improve the symptoms of PSH. To our knowledge, this is the first case report demonstrating the efficacy of trazodone for the treatment of PSH that developed after temporal subcortical hemorrhage. A 49-year-old woman presented to our clinic with mild confusion and sensory aphasia after experiencing left temporal subcortical hemorrhage; a conservative treatment was initiated at our hospital. Immediately upon hospitalization, she developed prolonged consciousness disorder, high fever, tachycardia, malignant hypertension, tachypnea, constipation, and overactive bladder. The patient's symptoms improved after the administration of trazodone. She was diagnosed with PSH after intracranial hemorrhage and was subsequently transferred to a recovery and rehabilitation hospital unit where the oral administration of trazodone continued. Prolonged PSH contributes significantly to the impairment of daily activities in patients with stroke; therefore, early diagnosis and treatment are critical. Here, we report on the efficacy of trazodone as an effective treatment option for improving clinical outcomes and reducing the stay in the stroke care unit.
阵发性交感神经过度兴奋（PSH）是一种以交感神经系统活动异常阵发性激增为特征的临床病症。已知PSH发生在严重颅脑损伤和缺氧性脑病之后。全球范围内均有关于中风后发生PSH的病例报道；然而，在日本的中风研究领域，PSH并不常见。一些研究表明加巴喷丁可能改善PSH的症状。据我们所知，这是首例证明曲唑酮对颞叶皮质下出血后发生的PSH有治疗效果的病例报告。一名49岁女性在经历左侧颞叶皮质下出血后，以轻度意识模糊和感觉性失语前来我院就诊；我院开始进行保守治疗。入院后，她立即出现了意识障碍延长、高热、心动过速、恶性高血压、呼吸急促、便秘和膀胱过度活动症。给予曲唑酮后患者症状改善。她被诊断为脑出血后PSH，随后被转至康复医院病房，继续口服曲唑酮。持续性PSH对中风患者的日常活动能力损害显著；因此，早期诊断和治疗至关重要。在此，我们报告曲唑酮作为一种有效治疗选择，可改善临床结局并缩短中风护理单元住院时间的疗效。
