Ca lâm sàng: Cơn cường giao cảm kịch phát sau đột quỵ nhồi máu não cấp

Abstract

Background: Paroxysmal sympathetic hyperactivity (PSH) may occur after acute ischemic stroke. The clinical presentation of PSH results from increased sympathetic overdrive, including transient paroxysms of tachycardia, hypertension, hyperventilation, hyperthermia, dystonic posturing, and excessive sweating. The exact pathophysiology of PSH, however, remains unclear, and no definitive treatment is available. Case presentation: Herein, the authors report a case of PSH in a female patient who experienced an acute ischemic stroke, for which a good clinical outcome. An 88-year-old woman was admitted to 108 Military Central Hospital. She had a Glasgow Coma Scale (GCS) score of 9 (M4V2E3), right hemiplegia, NIHSS score of 29. At admission, computed tomography revealed a reduction in the density of the left hemisphere, the blood supply area of the left middle cerebral artery (ASPECT 2 points). 12 days after ischemic stroke, the patient was diagnosed with PSH based on PSH-AM score (19 points). Morphine, gabapentin, and baclofen were administered; the drug effect was sufficient. 17 days poststroke, the patient gradually recovered from the adrenergic symptoms of PSH, and head computed tomography performed 12 days after stroke revealed improvement. Ultimately, the patient recovered with GCS score of 12 (M5V3E4), NIHSS score of 16, and lived at home. Conclusion: The outcome of the present case demonstrates that PSH can be reversed if it is identified early and before it becomes irreversible, that is, post the development of hypoxic encephalopathy or hemorrhagic transformation in ischemic stroke. * Keywords: Paroxysmal sympathetic hyperactivity; Acute ischemic stroke.