[A case of post-hemiplegic painful dystonia following thalamic infarction with good response to botulinus toxin].

摘要: We report a 67-year-old hypertensive right-handed woman who developed severe pain and dystonia in her left upper lower extremity after thalamic infarction. She was well until 9 months prior to the present admission our hospital, when she had an acute onset of hemiparesis which turned out have been caused by infarct. Her showed nearly complete recovery during next four months. noted spontaneous difficulty using hand admission. Neurologic examination on revealed alert oriented Japanese woman. Cranial nerves were intact. Although did not weakness, posture, upon standing, dystonic posture forearm took pronation flexion at elbow joint extension knee planter ankle joint. increased walking disappeared supine position. complained tingling sensation extremities. Position sense diminished leg. However other sensations slight ataxia side. Deep tendon reflexes symmetric, but response extensor MRI small lacunar infarct involving right posterolateral region. EMG with surface electrodes non-reciprocal tonic discharges biceps brachii flexor muscles. responded poorly various medications. Only trihexyphenidyl partial alleviation posture. thought might be contraction skeletal muscles, least part. injected 25 IU botulinus toxin as total dose into brachii, triceps wrist A few days injection, began show marked improvement; improved, also improvement. This patient appeared represent case post-hemiplegic dystonia. initially pain. However, improvement dystonia, is most likely muscle contraction. Botulinus treatment appears useful for painful