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Rehabilitation Practice and Science

Translated Title

小腦中風之排尿障礙：病例報告

Abstract

Animal studies have suggested that the cerebellum plays an inhibitory role in the collecting phase and a facilitatory role in the emptying phase of the voiding reflex in the micturition cycle.A 12 year old girl was admitted who complained of a headache and had a disturbance in consciousness after running in school. An emergent brain computed tomography scan showed massive bleeding over bilateral cerebellum hemispheres, vermis, and ventricles. An occipital craniotomy was performed to remove the hematoma. Simultaneously, an arterio-venous malformation was found and excised. She regained consciousness 3 weeks later, thereafter urine retention was noted as well as trunkal ataxia, upper and lower limb dysmetria, dysarthria, and dysphagia. Videourodynamic studies (VUD), performed 4 months after the onset of the stroke, showed detrusor areflexia with intermittent external sphincter contractions. An intermittent catheterization program was administered and voluntary urination began one week later. Though frequent urination and urgency were noted, she remained continent and the amount of residual urine decreased gradually. A followed up VUD at 6 weeks revealed detrusor hyperreflexia, which occurred in a bladder volume of 126 ml with an intravesical pressure of 95 cmH2O. In addition, intermittent detrusor external sphincter dyssynergia was detected. Upon a reviewarticle of the literature, there were few reports examining neurogenic voiding dysfunction after cerebellum lesion. This case study exhibited detrusor areflexia in the acute stage of a cerebellum lesion, detrusor hyperreflexia in recovery phase, and a positive outcome after bladder training.

Language

Traditional Chinese

First Page

67

Last Page

72

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