Introduction
Cerebrolysin, which consists of peptides and amino acids and is extracted from pig brain tissue, is a nootropic drug with neuroprotective and neurotrophic properties. It was reported to improve the neurological outcomes of stroke. However, the effect of cerebrolysin on disorders of consciousness (DOC) is still unknown. Here, we show a case suggesting effect of cerebrolysin on DOC secondary to intracranial hemorrhage(ICH).
Case
A 41-year-old man who had no medical history did not wake up in the morning with vestige of vomiting around him on Sep 23, 2018. He was found to be in stuporous condition responding only to painful stimuli. He was diagnosed with an intracranial hemorrhage in the left frontal lobe combined with subarachnoid hemorrhage secondary to rupture of left posterior communicating artery aneurysm. He underwent coil embolization and surgery of craniectomy and hematoma evacuation at the day of onset. After postoperative monitoring in the intensive care unit, he was transferred to the Department of Rehabilitation Medicine(RM) for comprehensive rehabilitation therapy days after the onset of the illness. On the day of transfer to RM (Oct 25, 2018), the total score of CRS-R was 8 (auditory function scale-2, visual function scale-2, motor function scale-2, oromotor/verbal function scale-0, communication scale-1, and arousal scale-1), which meant that he was barely able to fixate eyes on target. He also showed definite sleep cycle. Keppra 500mg was administered as anti-epileptics twice a day. On the 38th day after onset (Oct 30, 2018), Cerebrolysin (2.152g/10ml) twice a day (at 6AM and 6PM) started to be administered intravenously. Three days after the initiation of Cerebrolysin treatment, he began to raise his hands up to his head, which had not been observed before. On the 7th day of Cerebrolysin administration, he started to reach objects purposefully with his arms (total score of CRS-R was 15 (auditory function scale-3, visual function scale-4, motor function scale-3, oromotor / verbal function scale-1, communication-1, arousal scale-3). On the 14th day, he started to use the objects functionally, which meant that he had emerged from minimally conscious state. On the 25th day of drug administration, the total score of CRS-R went up to 20 (auditory function scale-4, visual function scale-4, motor function scale-6, oromotor/verbal function scale-1, communication-1, arousal scale-3). He was transfered to Department of Neurosurgery and underwent Cranioplasty surgery on 68th day after onset (Nov 29, 2018). He was transferred to RM on 40th day of Cerebrolysin administration (Dec 08, 2018) and showed the MMSE(MiniMental Status Exam) score 11. On 43th day of Cerebrolysin administration(Dec 11, 2018), MMSE score 12. The patient was discharged and transferred to another hospital on Dec 24th, 2018.
Conclusion
Cerebrolysin could be potent agent with significant effect on DOC secondary to ICH. |
