An unusual case of Dantrolene sodium-induced urinary retention in post-traumatic minimally responsive state.

INTRODUCTION: An unusual case of urinary retention is reported occurring during the inpatient rehabilitation of minimally responsive state (MRS) following severe traumatic brain injury (TBI). CLINICAL PICTURE: Urodynamic evaluation showed detrusor acontractility and subsequent management involved intermittent bladder catheterization and treatment of a single urinary tract infection. TREATMENT: Factors contributing to her bladder paralysis included severe immobility, tetraplegia and treatment of diffuse spasticity with oral Dantrolene sodium 250 mg per day. Constipation, diabetes and spinal cord injury were absent. In addition, she received unilateral partial sciatic neurolysis with 50% alcohol for severe knee flexor spasticity and intra-muscular Botulinum toxin A to both spastic upper limbs. OUTCOME: Bladder acontractility resolved completely when Dantrolene was reduced with subsequent achievement of a catheter-free status and small post-void residual volumes. Repeat urodynamics showed spontaneous detrusor contractions. CONCLUSION: A discussion of possible aetiologic factors for detrusor acontracility following TBI is presented including a brief review of the literature.

Rehabilitation outcome after primary subarachnoid haemorrhage.

Functional outcome of primary subarachnoid haemorrhage survivors was examined following rehabilitation in Singapore. Thirty-nine inpatients admitted over a 4-year period were studied retrospectively. There were 21 (53.8%) males and 18 (46.2%) females, mean age 50.9 (SD 12.7) years, at 37.3 days (SD 16.8) post-injury. Seven (17.9%) had dysphagia and 12 (30.8%) had dysphasia; 17 (43.6%) nondysphasics had cognitive impairment; 26 patients (66.7%) had Medical Research Council motor power under grade 4. Modified Barthel Index on Admission (MBIA) and Discharge (MBID) were 45.7 (SD 22.3) and 78.3 (SD 18.9), respectively (p = 0.001). Correlation between MBIA and MBID was statistically significant (r = 0.529, p = 0.001). Mean length of stay in rehabilitation was 42.3 days (SD 27.6). Thirty-four patients (87.2%) were discharged home. Nine out of 24 previously employed patients (37.5%) returned to gainful employment. Despite multiple deficits, the patients made significant functional improvement.

Intramuscular neurolysis with alcohol to treat post-stroke finger flexor spasticity.

OBJECTIVE: To evaluate the effectiveness of intramuscular neurolysis with alcohol for the treatment of finger flexor spasticity in individuals with stroke. DESIGN: Case series. SETTING: Outpatient clinic of a tertiary rehabilitation facility. SUBJECTS: Thirty patients with a mean age of 60.2 years and post-stroke duration of 8.3 months with finger flexor spasticity. INTERVENTIONS: Intramuscular neurolysis or motor point blocks of the finger flexors of the hemiplegic upper extremity with 50% ethyl alcohol. MAIN OUTCOME MEASURES: The severity of spasticity as measured by the Modified Ashworth Scale (MAS) and the passive range of motion of the proximal interphalangeal joints of the second to fifth digits. RESULTS: The mean baseline MAS score was 4.0 +/- 0.5 and this improved to 2.0 +/- 0.6, 2.2 +/- 0.6 and 2.6 +/- 0.6 at four weeks, three months and six months post neurolysis respectively. The gains in range of motion were 18.5 +/- 6.7, 17.5 +/- 6.4 and 14.9 +/- 4.8 degrees at four weeks, three months and six months post neurolysis respectively. These improvements were statistically significant (p < 0.05). Two subjects developed temporary dysesthetic pain of the forearm and palm. CONCLUSION: Intramuscular neurolysis with alcohol provides good relief of finger flexor spasticity in hemiplegic individuals.