Brainstem hemorrhage after neural therapy for decreased libido in a 31-year-old woman

Abstract

In September 2010, a 31-year-old otherwise healthy, female Caucasian consulted a dermatologist with additional qualifications in neural therapy because of decreased libido resistant to treatment. Following unproblematic procaine 1% injections at multiple gynecological and thyroidal sites, per os epipharyngeal injection was performed intending to infiltrate a neural therapy trigger point close to the pharyngeal tonsil at the anterior aspect of the sphenoid bone. This target point is assumed to represent remnants of the craniopharyngeal duct and Rathke’s pouch and is considered the source of various hormone imbalances [1]. Immediately after injection of 1 ml procaine, the patient developed right-sided brachiocrural hemiparesis, numbness of all limbs, nausea, vomiting, and rotatory vertigo. Approximately 30 min later, sensorimotor deficits gradually subsided, the vertiginous patient was reassured and sent home with an appointment set for the next day. Since the patient still complained about vertigo, nausea, and repeated vomitus on the following day, she was admitted to the emergency department of our hospital. At initial presentation, the patient was fully alert and orientated. The clinical examination was notable for positional vertigo in right lateral position and gaze-provoked upbeat nystagmus. Furthermore, a slight deficit in sensibility on the anterior aspect of the right lower leg was detected. The remainder of the clinical examination and all laboratory results were normal. Magnetic resonance imaging revealed a hemorrhagic lesion of 3 mm in diameter in the left paramedian medulla oblongata with slight perifocal edema (Fig. 1). Contrast-enhanced magnetic resonance angiography showed no evidence of any vertebral or intracranial artery dissection. Hereafter the patient was transferred to the intermediate care unit for further observation and was started on ceftriaxone and metronidazole to cover for possible contamination of the cerebrospinal fluid and brain by enoral microflora. She made an uneventful recovery, which allowed transfer to the neurology ward on the following day. Six days after admission, the patient was discharged from the hospital without a neurological deficit or subjective discomfort. To what extent the primordial desire was influenced by this experience was not ascertainable. Neural therapy was first described by Walter and Ferdinand Huneke in 1925 [1]. Although lacking scientific evidence, it is a widely used complementary medical method in Europe to treat acute and chronic pain syndromes, circulatory, autoimmune, and vegetative dysregulations [1]. Neural therapy uses injections of local anesthetics into or close to pathologically altered body regions such as scars, peripheral nerves, autonomic ganglia, glands, or other trigger points. Numerous adverse events have been reported following neural therapy, particularly when deep structures or internal organs were targeted [2–4]. So far, only one case of central nervous system hemorrhage has been reported. In 1979, Heyll and C. A. Schmittinger M. W. Dunser Department of Intensive Care Medicine, Inselspital, Bern Medical University, Bern, Switzerland