Antipsychotic-Induced Hypothermia After Starting Aripiprazole for Posttraumatic Agitation Management: A Case Report.

OBJECTIVES: Antipsychotic-induced hypothermia is an uncommon type of secondary hypothermia resulting from neurotransmitter derangements within the nervous system thermoregulation pathway. The most common causative medications include olanzapine, haloperidol, and risperidone, with one published report of aripiprazole. Most individuals who develop antipsychotic-induced hypothermia receive neuroleptic treatment for psychiatric disorder management, with significantly fewer occurrences in those with neurologic disorders. There are currently no reports of antipsychotic-induced hypothermia after a traumatic brain injury (TBI), where antipsychotics are used for the off-label management of posttraumatic agitation. METHODS: A retrospective chart review of the patient's medical record was performed. RESULTS: We present a case of a 56-year-old man with a moderate TBI who developed recurrent episodes of antipsychotic-induced hypothermia after starting aripiprazole for posttraumatic agitation management. CONCLUSIONS: To our knowledge, this is the first publication detailing antipsychotic-induced hypothermia occurring in a TBI patient. Clinicians who initiate antipsychotics for posttraumatic agitation in a TBI patient should be aware of this potential adverse effect, as well as clinical presentation, evaluation, and management strategies.

Spasticity management and resolution of paroxysmal sympathetic hyperactivity in the acute care setting: a case series.

OBJECTIVE: The aim is to highlight three cases of focal spasticity and/or dystonia as potential noxious triggers and treatment targets of Paroxysmal Sympathetic Hyperactivity (PSH). METHODS: We review the literature, explore pathophysiology, and review treatment options. We discuss the clinical course and management of three unique patients who presented to a teaching hospital with severe traumatic brain injury (TBI) complicated by PSH managed by a physiatry consult team. RESULTS: Three patients, ranging in age from 8 months to 27 years, were admitted with severe TBI complicated by PSH refractory to pharmacologic management. All three patients, however, had resolution of PSH within 24-72 hours of focal spasticity treatments (i.e. casting and botulinum toxin injections). CONCLUSION: PSH is a constellation of physiologic findings and physical symptoms that is incompletely understood. Management is based on addressing predominant symptom features and physiologic responses. In certain cases, ongoing spasticity and/or dystonia may serve as noxious stimuli for persistence of PSH in moderate to severe brain injury. As such, the focal treatment of spasticity and/or dystonia may be considered as a treatment target in the management of refractory PSH.

Functional Improvement of Tacrolimus-Induced Parkinsonism With Amantadine After Liver Transplantation: A Case Report.

ABSTRACT: Drug-induced parkinsonism is the most common type of drug-induced movement disorder, whose symptoms can decrease patient quality of life and reduce medication compliance. Tacrolimus is a routinely used immunosuppressant agent after liver transplantation, with a well-known neurotoxic profile. There have been rare reports of tacrolimus-induced parkinsonism, but its pharmacologic management and functional impact remain poorly characterized in the literature. We present a case of tacrolimus-induced parkinsonism in a 62-year-old man after a liver transplant, resulting in significant neurologic impairments and multiple barriers to hospital discharge. His tremor, rigidity, bradykinesia, gait dysfunction, dysphonia, and dysphagia significantly improved after starting low-dose amantadine, with increased functional independence that allowed for a safe discharge. This is the first case in the literature detailing tacrolimus-induced parkinsonism's functional impairments improving with amantadine monotherapy.

COVID-19 Ischemic Strokes as an Emerging Rehabilitation Population: A Case Series.

There is emerging literature that coronavirus disease 2019 infections result in an increased incidence of thrombosis secondary to a prothrombotic state. Initial studies reported ischemic strokes primarily occurring in the critically ill coronavirus disease 2019 population. However, there have been reports of ischemic strokes as the presenting symptom in young noncritically ill coronavirus disease 2019 patients without significant risk factors. Further characterization of the coronavirus disease 2019 stroke population is needed. We present four cases of coronavirus disease 2019 ischemic strokes occurring in patients aged 37-68 yrs with varying coronavirus disease 2019 infection severities, premorbid risk factors, clinical presentations (eg, focal and nonfocal), and vascular distributions. These cases highlight the heterogeneity of coronavirus disease 2019 ischemic strokes. The duration of the coronavirus disease 2019-related prothrombotic state is unknown, and it is unclear whether patients are at risk for recurrent strokes. With more coronavirus disease 2019 patients recovering and being discharged to rehabilitation, physiatric awareness of this prothrombotic state and increased incidence of ischemic strokes is essential. Because of the variable presentation of coronavirus disease 2019 ischemic strokes, clinicians can consider neuroimaging as part of the evaluation in coronavirus disease 2019 patients with either acute focal or nonfocal neurologic symptoms. Additional studies are needed to clarify prothrombotic state duration, determine prognosis for recovery, and establish the physiatrist's role in long-term disease management.