Ann Rehabil Med.  2015 Apr;39(2):308-312. 10.5535/arm.2015.39.2.308.

Paroxysmal Autonomic Instability With Dystonia Managed Using Chemodenervation Including Alcohol Neurolysis and Botulinum Toxin Type A Injection: A Case Report

• Lee HS
• Oh HS
• Shin JH

• KMID: 2273054
• DOI: http://doi.org/10.5535/arm.2015.39.2.308

Abstract

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.

Keyword

Paroxysmal autonomic instability with dystonia; Botulinum toxins; Nerve block; Dystonia; Autonomic nervous system

MeSH Terms

Adult
Autonomic Nervous System
Botulinum Toxins
Botulinum Toxins, Type A*
Brain Injuries
Dystonia*
Female
Fever
Humans
Hypertension
Liver Function Tests
Musculocutaneous Nerve
Nerve Block*
Tachycardia
Tachypnea
Thyroid Gland
Vital Signs
Botulinum Toxins
Botulinum Toxins, Type A