Hashizaki Takamasa, Nishimura Yukihide, Kinoshita Tokio, Minami Kohei, Kawanishi Makoto, Umemoto Yasunori, Tajima Fumihiro
Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan.
Division of Rehabilitation, Wakayama Medical University Hospital, Wakayama, Japan.
Front Neurol. 2023 Jul 13;14:1153941. doi: 10.3389/fneur.2023.1153941. eCollection 2023.
Although thrombocytopenia, anasarca, fever, reticulin fibrosis/renal failure, and organomegaly (TAFRO) syndrome was first reported in 2010, its pathogenesis and prognosis are still unknown. Moreover, reports on rehabilitation in patients with TAFRO are limited. In severe cases, dyspnea and muscle weakness could impede improvements in activities of daily living (ADL). However, reports on exercise intensity showed no worsening of TAFRO within the load of 11-13 on the Borg scale. Herein, we describe the rehabilitation and progress in a 61-year-old woman with TAFRO syndrome complicated by cerebral infarction from early onset to discharge. After cerebral infarction onset in the perforating artery, she was admitted to the intensive care unit due to decreased blood pressure and underwent continuous hemodiafiltration. Two weeks following transfer to a general ward, the patient started gait training using a brace due to low blood pressure, respiration, and tachycardia. After initiating gait training, increasing the amount of training was difficult due to a high Borg scale of 15-19, elevated respiratory rate, and worsening tachycardia. Furthermore, there was little improvement in muscle strength on the healthy side after continuous training, owing to long-term steroid administration. On day 100 after transfer, the patient was discharged home with a T-cane gait at a monitored level. The patient had severe hemiplegia due to complications with severe TAFRO syndrome delaying early bed release and gait training; tachycardia; and respiratory distress. Additionally, delayed recovery from muscle weakness on the non-paralyzed side made it difficult for the patient to walk and perform ADLs. Despite these issues, low-frequency rehabilitation was useful. However, low-frequency rehabilitation with gait training, using a Borg scale 15-19 orthosis, did not adversely affect the course of TAFRO syndrome.
虽然血小板减少、全身性水肿、发热、网状纤维增生/肾衰竭和器官肿大（TAFRO）综合征于2010年首次报道，但其发病机制和预后仍不清楚。此外，关于TAFRO患者康复的报道有限。在严重情况下，呼吸困难和肌肉无力会妨碍日常生活活动（ADL）的改善。然而，关于运动强度的报道显示，在Borg量表11 - 13的负荷范围内，TAFRO并没有恶化。在此，我们描述了一名61岁患有TAFRO综合征并合并脑梗死的女性从早期发病到出院的康复情况及进展。在穿支动脉发生脑梗死后，她因血压下降被收入重症监护病房，并接受持续血液透析滤过治疗。转至普通病房两周后，由于血压低、呼吸问题和心动过速，患者开始使用支具进行步态训练。开始步态训练后，由于Borg量表高达15 - 19、呼吸频率升高和心动过速加重，增加训练量变得困难。此外，由于长期使用类固醇，持续训练后健康侧的肌肉力量几乎没有改善。转院后第100天，患者以带T形手杖的步态在监测下出院回家。该患者因严重TAFRO综合征并发症导致严重偏瘫，延迟了早期离床和步态训练；存在心动过速和呼吸窘迫。此外，非瘫痪侧肌肉无力恢复延迟，使患者行走和进行ADL变得困难。尽管存在这些问题，低频康复仍有帮助。然而，使用Borg量表15 - 19矫形器进行步态训练的低频康复对TAFRO综合征的病程没有不利影响。
