PNF technique combined with extracorporeal shock wave in the treatment of hemiplegia caused by upper cervical perimedullary arteriovenous fistula embolization:clinical experience and review of literature

Abstract

Purpose-Research of rehabilitation for postoperative dysfunction of Spinal dural arteriovenous fistula, especially perimedullary arteriovenous fistula, are still rare. This literature is a young patient with hemiplegia after embolization regained limb motor function by using extracorporeal shock wave to reduce muscle tension and PNF technique to enhance muscle strength and strengthen neural control. Methods-A 3-year and 11 months old girl fell down while riding a scooter and accidentally detected cervical spinal canal vascular malformation by brain MRI. The final diagnosis was perimedullary arteriovenous fistula with subarachnoid hemorrhage, C3-4 level. Total cerebrovascular angiography + spinal angiography + aortic arch angiography +C3-4 level perimedullary arteriovenous fistula interventional embolization was completed. The muscle strength of the right limb decreased after surgery, and the muscle strength of the right limb improved after dilation, vasodilation, and hormone shock therapy. At our initial assessment, we found that the patient could not lift the upper limb to hold a cup and could not stand. After 2 weeks of PNF technique combined with extracorporeal shock wave therapy, Manual Muscle Testing was used to evaluate the progress of muscle strength, modified Ashworh scale was used to evaluate muscle tension, and Barthel index was used to evaluate the dependence degree of daily life. The Time Up and Go Test and the Gaitwatch 3D Gait Analysis and Evaluation System are used to evaluate gait. Results-After 2 weeks of treatment, her motor function has been greatly recovered, she can lift the upper limbs, and walk independently. the score of the modified Ashworth scale(MAS) on Triceps Surae decreased from 2/5 to 1/5. Barthel index increased from 25/100 to 85/100. Deltoid strength increased from 1/5 to 3/5, Triceps strength increased from 1/5 to 4/5, Iliopsoas strength increased from 2/5 to 3/5, Quadriceps strength increased from 2/5 to 4/5, and tibialis anterior strength increased from 0/5 to 2/5. In gait, the hip joint and pelvis have almost the same movement trajectory as the left side in the stance phase and swing phase, but the ankle joint still has foot drop at the beginning and end of gait. Conclusions-PNF technique combined with extracorporeal shock wave could effectively improve the muscle tone, muscle strength, and gait of hemiplegia patients after upper cervical perimedullary arteriovenous fistula embolization. This literature reports a very rare case of hemiplegia after upper cervical perimedullary arteriovenous fistula embolization, which was able to walk independently after 2 weeks of rehabilitation.