A refractory head tremor appearing after volatile anesthesia combined with epidural anesthesia in a patient with spinocerebellar ataxia type 6

Abstract

A 64-year-old female patient with spinocerebellar ataxia type 6 was referred to our department for pancreatic cancer and anesthetized with volatile anesthesia combined with epidural anesthesia for pancreaticoduodenectomy. No complications arose during surgery. On postoperative day 4, a head tremor was noticed at the time of mobilization. The tremor was a postural and "no-no" tremor rather than an intention or resting tremor. The head tremor caused difficulty in eating and in other activities of daily living. No abnormal results were obtained by magnetic resonance imaging of the brain. The tremor was resistant to drugs, including anti-Parkinson drugs and benzodiazepines, and was therefore difficult to treat.

A Case of Orthognathic Surgery for Jaw Deformity in a Patient with Spinocerebellar Ataxia

“…Although some case reports describe surgery under general anesthesia in patients with SCA, 4 only one case of surgery under general anesthesia in a patient with SCA3 has been reported. 5 Moreover, orthognathic surgery has not been reported in any cases.…”

Sentinel Node Biopsy and Lumpectomy in a Patient with Machado–Joseph Disease

“…Volatile agents can also induce aberrant calcium release from the endoplasmic reticulum and cause neural cell damage; alterations in calcium homeostasis have been implicated in the pathogenesis of SCA [17]. Further, there is a case report describing refractory head tremor a er volatile anesthesia in a patient with SCA6 [18]. erefore, volatile anesthetics should be used carefully in patients with MJD.…”

Tremor in Spinocerebellar Ataxia: A Scoping Review

“…In a series of seven SCA6 patients, three showed a nodding head tremor [ 120 ]. Intriguingly, a patient of SCA6 who underwent pancreaticoduodenectomy, developed a refractory head tremor after receiving anesthesia and metoclopramide [ 121 ].…”