中暑合併小腦運動失調之復健：案例報告

Rehabilitation of Heat Stroke with Cerebellar Motor Dysfunction: A Case Report

楊宗茗(Tsung-Ming Yang) ； 陳若佟(Jo-Tong Chen) ； 洪偉智(Wei-Chih Hung) ； 郭乃文(Nai-Wen Guo) ； 官大紳(Ta-Shen Kuan)

《台灣復健醫學雜誌》 34卷3期 (2006/09) Pp. 189-194

https://doi.org/10.6315/2006.34(3)08

摘要

中暑是一項可能造成多重器官衰竭並危及生命的急症。過去的研究顯示：大部分存活的病人可以完全康復而不存留後遺症，僅有少部分的病人會有長期的神經功能缺損，其中又以小腦神經細胞因對高溫特別敏感，常會導致小腦萎縮而遺留功能障礙。針對這些神經功能有障礙的中暑病人，其復健成效如何極少被討論。本文報告一位31歲的男性病人，中暑後發生急性橫紋肌溶解症、腎臟衰竭、呼吸衰竭、心律不整及小腦運動失調等合併症。病人在病發第36天，因運動失調、吶吃、情緒不易控制、性格改變等問題，轉到本院復健科。理學及神經學檢查顯示：病患有明顯的小腦運動失調，無法獨立行走，日常生活幾乎完全仰賴家人照顧。復健治療處方包括平衡訓練，肌力訓練，行走訓練，日常生活活動訓練，語言訓練以及心理復健衡鑑和介入等。二個月後的追蹤顯示，經過積極復健治療後，病人的運動失調及日常生活功能有顯著的改善，可以獨立行走且其日常生活活動完全可以獨立自主。這個病例顯示復健對於中暑合併有小腦運動失調的病人應扮演相當重要的角色。

關鍵字

中暑 ； 小腦運動失調

並列摘要

Heat stroke is a medical condition, which in its severest form, may lead to multiple organ failure and death. A previous study showed that most survivors recover completely without sequelae, but some survivors have long-term neurological dysfunction, especially cerebellar motor dysfunction. The rehabilitative outcome of such patients with neurological dysfunction has rarely been reported.
We present herein a case of a 31 year old male who suffered from heat stroke, followed by acute rhabdomyolysis, renal failure, respiratory failure, cardiac arrhythmia, and cerebellar motor dysfunction. He was transferred to our rehabilitation ward 36 days after the heat stroke injury due to ataxia, dysarthria, poor emotional control, and a personality change. Physical and neurologic examinations clearly revealed that the patient had cerebellar motor dysfunction. He was unable to walk without assistance and needed his family to help him with activities of daily living. The rehabilitation program included balance training, strengthening exercises, ambulation training, self-care training, speech training, and psychotherapy. After rehabilitation for two months, he exhibited significant improvement in ataxia and activities of daily living. Specifically, he could walk without assistance and functioned virtually independent of others in everyday activities. As illustrated by this case, an individualized rehabilitation program may play an important role in heat stroke patients with cerebellar motor dysfunction.

並列關鍵字

heat stroke ； cerebellar motor dysfunction