Stroke
Richard Fagbemigun, MD, MSc
Resident Physician(PGY-2)
Johns Hopkins Hospital
Baltimore, Maryland, United States
Samuel Ighodaro, n/a
4th Year Medical Student
Philadelphia College of Osteopathic Medicine
Lawrenceville, Georgia, United States
Fatimah B. Alhassan, BS
Medical Student
Thomas Jefferson Univeristy
Philadelphia, Pennsylvania, United States
Tracy Friedlander, MD
Attending Physician
Johns Hopkins Hospital
Baltimore, Maryland, United States
Richard Fagbemigun, MSc
George Washington University School of Medicine & Health Sciences
Washington, District of Columbia, United States
A 49-year-old man diagnosed with a left posterior inferior cerebellar artery(PICA) infarction.
Case Description:
He initially presented to an acute care hospital with headache, vertigo and difficulty ambulating. He was found to have a left PICA stroke and underwent suboccipital craniectomy for decompression. On admission to an inpatient rehabilitation facility, he was noted to have persistent fatigue, poor attention and reduced engagement with therapy. Caffeine supplementation and sleep-wake cycle optimization were trialed without much benefit. Amantadine 100mg twice daily was then started as a neurostimulant. Four days after initiation, therapists noted significant improvement in his arousal, attention and participation in therapy. He also had slight improvements in his AM PAC scores, going from 10 to 11 on his basic mobility scores and from 12 to 15 on his inpatient daily activity scores. These changes correlate with greater functional gains. Amantadine appeared to safely and effectively improve arousal, motivation, and rehabilitation engagement in this patient, suggesting a potential role in enhancing functional recovery in patients with post-stroke lethargy.
Discussions: Amantadine is a dopaminergic and NMDA antagonist that modulates arousal and frontal-subcortical pathways. It has been used as a first-line agent, with known benefits, in patients with traumatic brain injury and disorders of consciousness. However, the usage of amantadine in the setting of acute ischemic stroke has been less established, with unclear practice guidelines. While current literature has been limited to small studies, this case report adds to emerging evidence of the benefits of early amantadine initiation, particularly within this patient population. In this case, amantadine led to rapid improvement in attention, wakefulness, and therapy participation within four days of administration, facilitating progression from a lethargic to an engaged state.
Conclusions:
