Abstract
Severe paroxysmal sympathetic overactivity occurs in a subgroup of patients with acquired brain injuries including traumatic brain injury, hypoxia, infection and tumor-related complications. This condition is characterized by sudden increase of heart rate, respiratory rate, blood pressure, body temperature and excessive diaphoresis. The episodes may be induced by external stimulation or may occur spontaneously. Frequent occurrence of this condition could result in secondary morbidities, therefore, should be diagnosed and managed insightfully. These symptoms could be confused with seizures or other medical conditions, leading to unnecessary treatment. Despite clinical significance of paroxysmal sympathetic hyperactivity (PSH), brain tumor-induced PSH has not been studied nearly. In this report, two cases of the PSH in patients with brainstem-compressing benign tumors were introduced. The most useful pharmacologic agents were opioid (e.g., fentanyl patch) in preventing PSH attack, and nonselective β-blocker (e.g., propranolol) in relieving the symptoms. Clinical experiences of the rare cases of benign tumor-induced PSH can be helpful as an essential basis for further research.
Highlights
Episodes of acute sympathetic disturbances may occur after acquired brain injuries, such as traumatic brain injury, hypoxia, infection, and tumor-related complications (Baguley et al 2004; Baguley et al 2007)
Recent systemic reviews about this phenomena have been converged to the paroxysmal sympathetic hyperactivity (PSH) because of well-delineation of clinical features such as increasing of heart rate (HR), respiratory rate (RR), blood pressure (BP), body temperature (BT), diaphoresis and extensor muscle tones (Table 1)
The pathophysiology of the PSH is still elusive, it appears to be evident that brainstem injury is associated with the PSH
Summary
Episodes of acute sympathetic disturbances may occur after acquired brain injuries, such as traumatic brain injury, hypoxia, infection, and tumor-related complications (Baguley et al 2004; Baguley et al 2007). At 23 days after surgery, it was often showed that the paroxysmal increase of heart rate, respiratory rate, blood pressure and extensor posturing responding to non-noxious stimuli such as bathing and turning of body These symptoms were repeated and lasted for several minutes and spontaneously subsided. Case 2 A 30-year-old man was referred with stupor consciousness from other hospital after primary surgery He was diagnosed as the huge sized jugular foramen schwannoma with compressing brainstem (Fig. 4a). At 2 weeks after surgery, the paroxysmal increase of the heart rate, respiratory rate and blood pressure was observed, as well as extensor posturing, reactive to bathing or repositioning of the body These symptoms were resolved spontaneously within several minutes.
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