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KMID : 0361420150390020308
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Journal of Korean Academy of Rehabilitation Medicine
2015 Volume.39 No. 2 p.308 ~ p.312
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Paroxysmal Autonomic Instability With Dystonia Managed Using Chemodenervation Including Alcohol Neurolysis and Botulinum Toxin Type A Injection: A Case Report
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Lee Hye-Sun
Oh Hyun-Seung
Shin Joon-Ho
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Abstract
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Paroxysmal autonomic instability with dystonia (PAID) is a rare complication of brain injury. Symptoms of PAID include diaphoresis, hyperthermia, hypertension, tachycardia, and tachypnea accompanied by hypertonic movement. Herein, we present the case of a 44-year-old female patient, who was diagnosed with paraneoplastic limbic encephalopathy caused by thyroid papillary cancer. The patient exhibited all the symptoms of PAID. On the basis that the symptoms were unresponsive to antispastic medication and her liver function test was elevated, we performed alcohol neurolysis of the musculocutaneous nerve followed by botulinum toxin type A (BNT-A) injection into the biceps brachii and brachialis. Unstable vital signs and hypertonia were relieved after chemodenervation. Accordingly, alcohol neurolysis and BNT-A injection are proposed as a treatment option for intractable PAID.
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KEYWORD
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Paroxysmal autonomic instability with dystonia, Botulinum toxins, Nerve block, Dystonia, Autonomic nervous system
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