Table 1 Summary of key events in the patient’s clinical course
From: Ketamine for acute management of refractory stiff person syndrome: a case report
Date | Event | Interventions | Outcome |
|---|---|---|---|
April 9, 2024 | Initial presentation with acute flare triggered by fire alarm | Oral diazepam (30 mg), IV methocarbamol (1,000 mg every 8 h), low-dose ketamine; ICU transfer for high-dose ketamine | Partial symptom improvement; discharged on April 15 with persistent anxiety and dissatisfaction |
April 16, 2024 | Re-presentation with stiffness on the left side and right lower extremity | Life flight; ketamine (25 mg × 2 en route, 50 mg IV in ED) | Complete symptom resolution; discharged same day |
April 18, 2024 | Third presentation with stiffness in all limbs, chest tightness, and shortness of breath | IV ketamine (50 mg), cyclobenzaprine (10 mg every 8 h), acetaminophen (975 mg TID), as needed methocarbamol | Symptoms improved; hospitalized with complications including hypoxia, DVT, and concussion |
April 30, 2024 | Discharged following prolonged hospitalization | Tapering hydromorphone, baclofen, oral clonazepam (0.5 mg), hydroxyzine (50 mg) | Improved symptoms, anxiety partially managed |
August 2024 | Transition from IVIG to plasmapheresis due to side effects | Biweekly IVIG therapy switched to plasmapheresis | Symptom-free period until relocation |
November 1, 2024 | Flare triggered by environmental stressors in new dorm room | Lorazepam (10 mg at home), IV lorazepam (8 mg), diazepam (10 mg QID), baclofen (20 mg TID), IV fluids; later 50 mg IV ketamine in ICU | Symptoms resolved; discharged next day |
November 3–4, 2024 | Recurrence of symptoms | IV ketamine (50 mg each visit) | Symptom-free following treatment |