暴风雨与沉寂：脑缺氧后出现紧张症和阵发性交感神经兴奋的病例报告。
Storms and silence: a case report of catatonia and paroxysmal sympathetic hyperactivity following cerebral hypoxia.
机构信息
Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA, USA.
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
出版信息
BMC Psychiatry. 2020 Sep 29;20(1):473. doi: 10.1186/s12888-020-02878-5.
BACKGROUND
Delayed Post Hypoxic Leukoencephalopathy (DPHL) is a syndrome that occurs after hypoxia, and can present with a variety of neuropsychiatric symptoms, including catatonia and paroxysmal sympathetic hyperactivity (PSH). The gold standard for the treatment of catatonia is electroconvulsive therapy (ECT). However, ECT can exacerbate the paroxysms of sympathetic hyperactivity and complicate recovery from DPHL. The treatment of PSH is not well established.
CASE PRESENTATION
We present a case of a patient with multiple opiate overdoses who presented with altered mental status. He was diagnosed with catatonia and subsequently treated with ECT. His clinical condition worsened, and a revised diagnosis of PSH was established. The patient's condition improved with medical management.
CONCLUSION
This case highlights the need to distinguish between these two related symptom clusters, as the incidence of DPHL and opioid overdose related neuropsychiatric problems increase. This distinction can greatly influence the course of treatment, and the need to consider alternative treatments.
背景
迟发性缺氧后脑白质病（DPHL）是一种在缺氧后发生的综合征，可表现出多种神经精神症状，包括紧张症和阵发性交感神经兴奋（PSH）。紧张症的治疗金标准是电休克疗法（ECT）。然而，ECT 可使交感神经兴奋的发作恶化，并使 DPHL 的恢复复杂化。PSH 的治疗尚未得到很好的确定。
病例介绍
我们介绍了一例因多种阿片类药物过量而出现意识改变的患者。他被诊断为紧张症，随后接受了 ECT 治疗。他的临床状况恶化，重新诊断为 PSH。患者的病情通过药物治疗得到改善。
结论
该病例强调需要区分这两个相关的症状群，因为 DPHL 和阿片类药物过量相关神经精神问题的发生率正在增加。这种区分可以极大地影响治疗过程，并需要考虑替代治疗方法。
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