Abstract
BackgroundWe report on the first case of successful treatment for post-anesthesia dementia with perispinal etanercept injection combined with hyperbaric oxygen therapy.Case presentationOur patient was a 77-year-old Caucasian man of Mexican ethnicity who presented to our clinic 4.5 years after a knee replacement surgery. Immediately post-surgery, the patient began to show dramatic cognitive, physical, and emotional impairment compared with his presurgical state; these symptoms were still present when he arrived at our clinic. A clinical assessment and brain single-photon emission computer tomography were performed. Diagnoses of dementia with major cognitive deficits and aphasia were established. A 40-session course of hyperbaric oxygen therapy was initiated to address our patient’s impairments. After the first ten hyperbaric oxygen therapy treatments, our patient was administered 25 mg perispinal etanercept injections approximately once weekly for 5 months. Starting after the first perispinal etanercept injection, our patient began showing progressive improvements. By the 5-month follow-up, his cognitive and physical function were substantially restored. A follow-up single-photon emission computer tomography scan showed increased perfusion in several small, localized areas.ConclusionsIn this case of dementia and major cognitive disorder post major surgery and anesthesia, the very beneficial effect of combining hyperbaric oxygen therapy with perispinal etanercept is outlined.
Highlights
We report on the first case of successful treatment for post-anesthesia dementia with perispinal etanercept injection combined with hyperbaric oxygen therapy.Case presentation: Our patient was a 77-year-old Caucasian man of Mexican ethnicity who presented to our clinic 4.5 years after a knee replacement surgery
We report on the first case, to the best of our knowledge, of the use of hyperbaric oxygen therapy (HBOT) followed by perispinal etanercept (PSE) injection to successfully treat dementia-like symptoms of sudden onset after orthopedic surgery with general anesthesia
Such symptoms can be related to pathologically prolonged microglial activation [1], which causes an excess of pro-inflammatory cytokine production, including tumor necrosis factor (TNF)-alpha
Summary
We report on the first case, to the best of our knowledge, of the use of hyperbaric oxygen therapy (HBOT) followed by perispinal etanercept (PSE) injection to successfully treat dementia-like symptoms of sudden onset after orthopedic surgery with general anesthesia. Based on our patient’s medical history and SPECT results, we hypothesized that he had experienced a cerebral insult during his knee surgery, namely that the injury resulted from multiple causes, including consequences of surgery, and anesthetic effects [14, 15] that created perfusion abnormalities simulating those observed after stroke To address these cognitive, physical, and emotional impairments, a treatment plan was prepared including both HBOT and PSE administration.. There was a significant perfusion increase in the striatum bilaterally At this point in time our patient is at 16 months since the end of the combined treatment and all the clinical improvements mentioned above are still maintained
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