Journal of Yeungnam Medical Science

Case Report

Exacerbation of spasticity in ipsilateral shoulder after right brachial plexus block in a patient with right hemiplegia.: Sang Jin Park, Jong Yoon Baek; Yeungnam Univ J Med. 2015;32(1):22-25. Published online June 30, 2015; DOI: https://doi.org/10.12701/yujm.2015.32.1.22

Abstract PDF: Spasticity is a common impairment in patients with central nervous system disease. Clinical observation has demonstrated that spasticity can be aggravated by various factors such as emotional state as well as noxious stimuli. A 51-year-old male patient was scheduled for arteriovenous fistula surgery. He had right hemiplegia including motor weakness and spasticity. It was decided that the surgery would be performed under an axillary brachial plexus block (BPB). He appeared nervous when blockade was terminated. The spasticity of the right shoulder increased after ipsilateral BPB. However, when we administered sedative drugs and performed interscalene BPB 2 days later, spasticity did not occur. Exacerbation of spasticity might be evoked by an anxious emotional state. Thus, it seems to be good to consider removing of anxiety and using an appropriate approach when it is tried to perform nerve blocks in individuals with spasticity.

Review Article

Neurosurgical Treatment for Cerebral Palsy Spasticity: Seong-Ho Kim, Byung-Yon Choi; Yeungnam Univ J Med. 2007;24(2 Suppl):S186-191. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S186

Abstract PDF: The spasticity of cerebral palsy is usually a useful substitute for deficiency of motor strength. However not infrequently, it may become harmful leading to an aggravation of motor disability. When excessive spasticity is not sufficiently controlled by physical therapy and pharmacological treatment, patients can have recourse to neurosurgery: neurostimulation, intrathecal baclofen or selective ablative procedures. Because excessive hypertonia has to be reduced without suppression of the useful muscular tone or impairment in the residual motor and sensory functions, neuroablative procedures must be as selective as possible. These selective lesions can be performed at the level of peripheral nerves, spinal roots, or the dorsal root entry zone(DREZotomy). The new neurological status brought about by the neurosurgical operation will reach its optimal level only if intensive, prolonged, comprehensive treatment is provided by an expert multidisciplinary team including rehabilitation medicine. The neurosurgical treatment must take place before the onset of irreversible articular disturbances and musculotendinous retractions, which require complementary orthopedic corrections.

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