The Rising Status of Phenobarbital: A Case for Use in Severe Refractory Hyperactive Poststroke Delirium.
Neurologist
; 28(2): 123-125, 2023 Mar 01.
Article
en En
| MEDLINE
| ID: mdl-35534002
ABSTRACT
INTRODUCTION:
Up to 48% of patients who have had a stroke will experience poststroke delirium (PSD) that can be hyperactive, hypoactive, or mixed. Literature on treatment of the hyperactive subtype is specifically lacking. This case report describes the rapid resolution of severe refractory hyperactive PSD with phenobarbital. CASE REPORT A 58-year-old man with a left middle cerebral artery stroke presented with severe hyperactive PSD of 12 days duration, refractory to antipsychotics, alpha-2 agonists, gabapentin, therapeutic valproic acid, benzodiazepines, and ketamine infusion. An oral dose of phenobarbital 30.4 mg, followed by oral maintenance therapy was initiated on day 13 of admission with dramatic improvement. As his Richmond Agitation-Sedation score trended downwards to 0, he was able to cooperate with therapies. This allowed for discharge to a skilled nursing facility for rehabilitation and subsequently home 2 weeks later.CONCLUSION:
Hyperactive PSD is a common complication of stroke with little evidence to guide treatment strategies. This report suggests that phenobarbital, because of its varied mechanisms of action and unique neurochemistry, may be an unrecognized potential therapy.
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Antipsicóticos
/
Delirio
Límite:
Humans
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Male
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Middle aged
Idioma:
En
Revista:
Neurologist
Asunto de la revista:
NEUROLOGIA
Año:
2023
Tipo del documento:
Article