Abstract
Streptococcus pneumoniae is a common cause of bacterial meningitis, frequently resulting in severe neurological impairment. A seven-month-old child presenting with Streptococcus pneumoniae meningoencephalitis developed right basal ganglia and hypothalamic infarctions. Daily episodes of agitation, hypertension, tachycardia, diaphoresis, hyperthermia, and decerebrate posturing were observed. The diagnosis of paroxysmal autonomic instability with dystonia was established. The patient responded to clonidine, baclofen, and benzodiazepines. Although this entity has been reported in association with traumatic brain injury, and as a sequel to some nervous system infections, this is the first case, to our knowledge, associated with pneumococcal meningoencephalitis.
Highlights
Paroxysmal autonomic instability with dystonia (PAID) syndrome is a relatively uncommon complication of various central nervous system (CNS) injuries
The clinical manifestations of this syndrome are characterized by intermittent agitation, diaphoresis, hyperthermia, tachycardia, hypertension, tachypnea, hypertonia, and extensor posturing [5]
Various mechanisms have been proposed for the paroxysmal dysautonomia seen in PAID syndrome
Summary
Paroxysmal autonomic instability with dystonia (PAID) syndrome is a relatively uncommon complication of various central nervous system (CNS) injuries. It has been reported in association with severe traumatic brain injury, brain anoxia, subarachnoid and intracranial hemorrhages, midbrain glioma, and occasionally hydrocephalus [1, 2]. Hypertension, fever, autonomic dysfunction, and extensor posturing are highly suggestive of PAID syndrome. Prompt recognition of this entity is crucial for the institution of proper and timely therapy
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