[Therapeutic effect of spinal cord stimulation for a patient suffering spasticity after hypoxia of the brain].
We reported a case of severe spasticity of the bilateral upper and lower limbs which was improved by cervical spinal cord stimulation (SCS). A 53-year-old man was suffering from sudden cardiopulmonary arrest while walking. After receiving cardiopulmonary resuscitation for 40 minutes, his cardiopulmonary function re-started, but he failed to regain consciousness. MRI revealed a hypoxic brain in his bilateral basal ganglia and occipital lobes. After 2 months, his consciousness advanced to a vegetative state and the muscle tone of his bilateral upper and lower limbs deteriorated to severe spasticity. SCS was performed in the expectation of improving his consciousness. Contrary to this anticipated result, his vegetative state continued but the severe spasticity of his upper and lower limbs improved during the SCS. Single photon emission computed tomography (SPECT) during the period of stimulation revealed a high blood flow, especially in the area of the basal ganglia, thalamus, brain stem and cerebellum, compared with off-stimulation blood flow. The neurophysiologic mechanisms of these abnormal fields and the underlying aberrant afferent nerve impulses from the posterior funiculus in the cervical cord to the cerebral sensory cortex, which may indeed be secondary to ischemic brain, may be regulated by SCS, also adding the effect of increased blood flow to the brain.
Terao
Tohru
T
Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital. tohru@jg7.so-net.ne.jp
Taya
Keisuke
K
Sawauchi
Satoshi
S
Numoto
Tomohiko R
TR
Murakami
Shigeyuki
S
Abe
Toshiaki
T
Hashimoto
Takuo
T
D001921:Brain / Q000473:pathology; D004599:Electric Stimulation Therapy; D006801:Humans; D002534:Hypoxia, Brain / Q000150:complications*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000209:etiology / Q000628:therapy*; D013116:Spinal Cord / Q000503:physiopathology*