medigraphic.com
Academia Mexicana de Neurología, A.C.

2012, Number 2

<< Back Next >>

Rev Mex Neuroci 2012; 13 (2)

Paroxistic sympathetic hyperactivity: Descritption of two pediatric cases and literature review

Domínguez-Jiménez E, Piña-Ramírez BM, García-Ramírez JL, Lambert-Cerda C, Arellano-De la Hoz JD, Bravo-Oro A

Language: Spanish
References: 35
Page: 98-103
PDF size: 468.08 Kb.


ABSTRACT

Introduction: Paroxysmal sympathetic hyperactivity occurs in association with several conditions that affect central nervous system. The main clinical manifestations are self-limited episodes of hypertension, tachycardia, tachypnea, hyperhidrosis, alterations in level of consciousness, excessive salivation, hypertonia with extensor posture, fever and pupillary dilation. Recognition is often delayed, which increases the morbidity and mortality. Case report: We report two pediatrics cases that developed sympathetic storm, one of them after a severe cranial trauma and the second case associated to hydrocephalus and hypoxic encephalopathy. Discussion: The pathophysiology remains unclear. Limited knowledge exist about the cerebral area involved or the specific biochemical abnormalities responsible for the syndrome. Some of the proposed mechanisms include heightened activity of the sympathoexcitatory centers in diencephalon or brainstem, with alterations in neurotransmitters. The pharmacological management with first-line drugs like morphine sulfate and betablockers are considered the most effective although the level of evidence is low as it is based on some small case reports. In our cases we use baclofen and propranolol with good control of the disorder. Conclusions: Early identification of paroxysmal sympathetic hyperactivity on high-risk patients is important to minimize unnecessary diagnostic testing and therapeutic interventions, as well as to promote timely and appropriate treatment and minimize secondary morbidity.


REFERENCES

  1. Baguley IJ, Nicholls JL, Felmingham KL, Crooks J, Gurka JA, Wade LD. Dysautonomia after traumatic brain injury: a forgotten syndrome? J Neurol Neurosurg Psychiatry 1999; 67: 39-43.

  2. Boeve BF, Wijdicks EF, Benarroch EE, Schmidt KD. Paroxysmal sympathetic storms (“diencephalic seizures”) after severe diffuse axonal head injury. Mayo Clin Proc 1998; 73: 148-52.

  3. Perkes I, Baguley IJ, Nott MT, Menon DK. A review of paroxysmal sympathetic hyperactivity after acquired brain injury. Ann Neurol 2010; 68: 126-35.

  4. Lewitt PA, Newman RP, Greenberg HS, Rocher LL, Caine DB, Ehrenkranz JR. Episodic hyperhidrosis, hypothermia, and agenesis of corpus callosum. Neurology 1983; 33: 1122-9.

  5. Solomon GE. Diencephalic autonomic epilepsy caused by a neoplasm. J Pediatr 1973; 83: 277-80.

  6. Giroud M, Sautreaux JL, Thierry A, Dumas R. Diencephalic epilepsy with congenital suprasellar arachnoid cyst in an infant. Childs Nerv Syst 1988; 4: 252-4.

  7. Talman WT, Florek G, Bullard DE. A hyperthermic syndrome in two subjects with acute hydrocephalus. Arch Neurol 1988; 45: 1037-40.

  8. Tong C, Konig MW, Roberts PR, Tatter SB, Li XH. Autonomic dysfunction secondary to intracerebral hemorrhage. Anesth Analg 2000; 91: 1450-1.

  9. Blackman JA, Patrick PD, Buck ML, Rust Jr. RS. Paroxysmal autonomic instability with dystonia after brain injury. Arch Neurol 2004; 61: 321-8.

  10. Rabinstein AA. Paroxysmal sympathetic hyperactivity in the neurological intensive care unit. Neurol Res 2007; 29: 680-2.

  11. Penfield W. Diencephalic autonomic epilepsy. Arch Neurol Psychiatry 1929; 22: 358-74.

  12. Baguley IJ. Autonomic complications following central nervous system injury. Semin Neurol 2008; 28: 716-25.

  13. Fearnside MR, Cook RJ, McDougall P, McNeil RJ.The Westmead Head Injury Project outcome in severe head injury. A comparative analysis of pre-hospital, clinical and CT variables. Br J Neurosurg 1993; 7: 267-79.

  14. Fernández-Ortega JF, Prieto-Palomino MA, Muñoz-López A, Lebron- Gallardo M, Cabrera-Ortiz H, Quesada-García G. Prognostic influence and computed tomography findings in dysautonomic crises after traumatic brain injury. J Trauma 2006; 61: 1129-33.

  15. Baguley IJ, Slewa-Younan S, Heriseanu RE, Nott MT, Mudaliar Y, Nayyar V. The incidence of dysautonomia and its relationship with autonomic arousal following traumatic brain injury. Brain Inj 2007; 21: 1175-81.

  16. Krach LE, Kriel RL, Morris WF, Warhol BL, Luxenberg MG. Central autonomic disfunction following acquired brain injury in children. J Neurol Rehabil 1997; 11: 41-5.

  17. Baguley IJ. The excitatory: inhibitory model (EIR model): an integrative explanation of acute autonomic overactivity syndromes. Med Hypotheses 2008; 70: 26-35.

  18. Horntagl H, Hammerle A, Hackl J, Brucke T, Rumpl E. The activity of the sympathetic nervous system following severe brain injury. Intensive Care Med 1980; 6:169-77.

  19. Baguley IJ, Heriseanu RE, Cameron ID, Nott MT, Slewa-Younan S. A critical review of the pathophysiology of dysautonomia following traumatic brain injury. Neurocrit Care 2008; 8: 293-300.

  20. Bullard DE. Diencephalic seizures: responsiveness to bromocriptine and morphine. Ann Neurol 1987; 21: 609-11.

  21. Kishner S, Augustin J. Post head injury autonomic complications. Last updated 2006 October 4. Available from: http://www.emedicine.com/ pmr/topic108.htm.

  22. Pranzatelli MR, Pavlakis SG, Gould RG, De Vivo DC. Hypothalamicmidbrain dysregulation syndrome: hypertension, hyperthermia, hyperventilation, and decerebration. J Child Neurol 1991; 6: 115-22.

  23. Baguley IJ, Cameron ID, Green AM, et al.: Pharmacological management of dysautonomia following traumatic brain injury. Brain Inj 2004; 18: 409-17.

  24. Rabinstein AA, Benarroch EE. Treatment of paroxysmal sympathetic hyperactivity. Curr Treat Options Neurol 2008; 10: 151-7.

  25. Sirén AL, Feuerstein G. The opioid system in circulatory control. News Physiol Sci 1992; 7: 26-30.

  26. Sandel ME, Abrams PL, Horn LJ. Hypertension after brain injury: Case report. Arch Phys Med Rehabil 1986; 67: 469-72.

  27. Lemke DM. Riding out the storm: sympathetic storm after traumatic brain injury. J Neurosci Nurs 2004; 36: 4-9.

  28. Chiolero RL, Breitenstein E, Thorin D, et al. Effects of propranolol on resting metabolic rate after severe head injury. Crit Care Med 1989, 17: 328-34.

  29. Do D, Sheen VL, Brumfield E. Treatment of paroxysmal sympathetic storm with labetalol. J Neurol Neurosurg Psychiatry 2000; 69: 832-3.

  30. Ener RA, Meglathery SB, Van Decker WA, Gallagher RM. Serotonin syndrome and other serotonergic disorders. Pain Med 2003; 4: 63-74.

  31. Russo RN, O’Flaherty S. Bromocriptine for the management of autonomic dysfunction after severe traumatic brain injury. J Paediatric Child Health 2000; 36: 283-5.

  32. Payen D, Quintin L, Plaisance P, et al.: Head injury: clonidine decreases plasma catecholamines. Crit Care Med 1990; 18: 392-5.

  33. Baguley IJ, Heriseanu RE, Gurka JA, Nordenbo A, Cameron ID. Gabapentin in the management of Dysautonomia following severe traumatic brain injury: a case series. J Neurol Neurosurg Psychiatr 2007; 78: 539-41.

  34. Cuny E, Richer E, Castel JP. Dysautonomia syndrome in the acute recovery phase after traumatic brain injury: relief with intrathecal Baclofen therapy. Brain Inj 2001; 15: 917-25.

  35. Becker R, Benes L, Sure U, Hellwig D, Bertalanffy H. Intrathecal baclofen alleviates autonomic dysfunction in severe brain injury. J Clin Neurosci 2000; 7: 316-9.




2020     |     www.medigraphic.com