悪性症候群後に小脳性運動失調をきたした1例

Abstract

A 17-year-old female with adjustment disorder repeated suicide attempts (self poisoning and cutting) several times due to unstable mental states such as impulsive behaviors. She developed neuroleptic malignant syndrome (NMS) after taking large amounts of drugs (analgesics and antipyretics) and was admitted to the emergency center at Nara Medical University. She was treated intensively, but cerebellar ataxia such as intention tremor and vertical nystagmus occurred subsequently after physical improvement. She understood spoken words, but did not speak any words herself. Some mental influences on her symptoms were suspected and she was moved to a psychiatric ward. We speculated that exposure to abnormal high temperature damaged Purkinje cells in the cerebellum and started to administer tartaric acid protirelin intravenously. Several days later explosive speech appeared and three months later atrophic changes were found in the cerebellar hemisphere by brain MRI. Her cerebellar ataxia was gradually improved by medication and physical therapy, and control of her impulsiveness was also improved by intrafamilial adjustment.