We report the case of a 36-year-old woman with a subarachnoid haemorrhage (SAH) caused by a rupture of a right-sided middle cerebral artery aneurysm and subsequent malignant infarction of the right hemisphere leading to a persistent vegetative state and severe spastic tetraparesis with recurrent myocloni. Nine months after disease onset, the patient was transferred to our department for diagnostic and therapeutic re-evaluation. The poor clinical condition could not be explained by the brain lesion caused by the SAH or infarction. Moreover, glucose metabolism was normal in brain regions not affected by SAH and infarction as shown by positron emission tomography with 18F-fluorodeoxyglucose. We terminated baclofen and reduced antiepileptics known to impair vigilance and cognitive functions. However, only after starting amantadine treatment we observed a stunning awakening of the patient fully orientated within days. Our findings warrant trials to investigate amantadine in the treatment of unresponsive wakefulness syndromes due to acute central nervous system diseases.
- Coma And Raised Intracranial Pressure
- Neuro ITU
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Contributors SML: design and conceptualisation of the case report, involved in clinical care, acquisition of data, analysis and interpretation of data, drafting of manuscript. FS: involved in clinical care, acquisition and interpretation of data, revision of manuscript for intellectual content. RB: acquisition, description and interpretation of PET data, revision of manuscript for intellectual content. SK: acquisition, description and interpretation of MRI data, revision of manuscript for intellectual content. A. Meisel: involved in conceptualisation of the case report, interpretation of data, revision of manuscript for intellectual content.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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