Paroxysmal sympathetic hyperactivity in a child with stroke: a case report
Abstract Background Paroxysmal sympathetic hyperactivity (PSH) is the result of dysregulated autonomic function with sympathetic symptoms characterised by increased heart rate, respiratory rate, blood pressure and temperature with abnormal posture, which predominately occur periodically but can be p...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SpringerOpen
2023-07-01
|
| Series: | Egyptian Pediatric Association Gazette |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s43054-023-00184-9 |
| _version_ | 1797779013283872768 |
|---|---|
| author | Jay Bhagwat Jomalkar Vineetha Vijayan Avanti Rajendra Saoji Abhinaya Vaidyanathan Praveen Unki Santosh Kondekar Surbhi Rathi Chandrahas T. Deshmukh |
| author_facet | Jay Bhagwat Jomalkar Vineetha Vijayan Avanti Rajendra Saoji Abhinaya Vaidyanathan Praveen Unki Santosh Kondekar Surbhi Rathi Chandrahas T. Deshmukh |
| author_sort | Jay Bhagwat Jomalkar |
| collection | DOAJ |
| description | Abstract Background Paroxysmal sympathetic hyperactivity (PSH) is the result of dysregulated autonomic function with sympathetic symptoms characterised by increased heart rate, respiratory rate, blood pressure and temperature with abnormal posture, which predominately occur periodically but can be persistent in severe cases. Common causes that present in similar fashion such as infectious process (bacteremia, meningitis, etc.); non-PSH neurological deterioration (increased intracranial pressure, intracranial haemorrhage, intracranial oedema, seizures, encephalitis); pulmonary embolism; thyrotoxicosis, alcohol or drug withdrawal; neuroleptic malignant syndrome; serotonin syndrome; and malignant hyperthermia need to be excluded before diagnosing PSH. The earlier the diagnosis made, the better the prognosis. Case presentation We report a case of a 3-year-old male child who was a diagnosed case of Tetralogy of Fallot presented with left focal seizure with secondary generalisation. Child also had respiratory complaints prior to convulsion. He had developed signs of raised intracranial pressure. Blood culture sent to rule out infective endocarditis was negative. CT brain showed bilateral diffuse cortical infarct. Child developed signs and symptoms of PSH such as fever, tachycardia, tachypnoea, hypertension, diaphoresis, dystonia and bilateral completely dilated pupils. Other common causes such as infective endocarditis, increased intracranial pressure, intracranial oedema, intracranial haemorrhage, seizure, encephalitis and infectious processes (bacteremia, meningitis and infective endocarditis) were ruled out. The diagnosis of PSH was made and started on propranolol along with clonidine. Child responded well to the treatment. Conclusion The complex pathophysiology of PSH warrants extensive work-up to rule out other common causes. The outcome of our patient shows the importance of early diagnosis and multidisciplinary treatment for better outcome. |
| first_indexed | 2024-03-12T23:25:38Z |
| format | Article |
| id | doaj.art-de5c2a9edb9c4bc1a8623424bf8cfe98 |
| institution | Directory Open Access Journal |
| issn | 2090-9942 |
| language | English |
| last_indexed | 2024-03-12T23:25:38Z |
| publishDate | 2023-07-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Egyptian Pediatric Association Gazette |
| spelling | doaj.art-de5c2a9edb9c4bc1a8623424bf8cfe982023-07-16T11:12:09ZengSpringerOpenEgyptian Pediatric Association Gazette2090-99422023-07-017111510.1186/s43054-023-00184-9Paroxysmal sympathetic hyperactivity in a child with stroke: a case reportJay Bhagwat Jomalkar0Vineetha Vijayan1Avanti Rajendra Saoji2Abhinaya Vaidyanathan3Praveen Unki4Santosh Kondekar5Surbhi Rathi6Chandrahas T. Deshmukh7Department of Paediatrics, Topiwala National Medical CollegeDepartment of Paediatrics, Topiwala National Medical CollegeDepartment of Paediatrics, Topiwala National Medical CollegeDepartment of Paediatrics, Topiwala National Medical CollegeDepartment of Paediatrics, Topiwala National Medical CollegeDepartment of Paediatrics, Topiwala National Medical CollegeDepartment of Paediatrics, Topiwala National Medical CollegeDepartment of Paediatrics, Topiwala National Medical CollegeAbstract Background Paroxysmal sympathetic hyperactivity (PSH) is the result of dysregulated autonomic function with sympathetic symptoms characterised by increased heart rate, respiratory rate, blood pressure and temperature with abnormal posture, which predominately occur periodically but can be persistent in severe cases. Common causes that present in similar fashion such as infectious process (bacteremia, meningitis, etc.); non-PSH neurological deterioration (increased intracranial pressure, intracranial haemorrhage, intracranial oedema, seizures, encephalitis); pulmonary embolism; thyrotoxicosis, alcohol or drug withdrawal; neuroleptic malignant syndrome; serotonin syndrome; and malignant hyperthermia need to be excluded before diagnosing PSH. The earlier the diagnosis made, the better the prognosis. Case presentation We report a case of a 3-year-old male child who was a diagnosed case of Tetralogy of Fallot presented with left focal seizure with secondary generalisation. Child also had respiratory complaints prior to convulsion. He had developed signs of raised intracranial pressure. Blood culture sent to rule out infective endocarditis was negative. CT brain showed bilateral diffuse cortical infarct. Child developed signs and symptoms of PSH such as fever, tachycardia, tachypnoea, hypertension, diaphoresis, dystonia and bilateral completely dilated pupils. Other common causes such as infective endocarditis, increased intracranial pressure, intracranial oedema, intracranial haemorrhage, seizure, encephalitis and infectious processes (bacteremia, meningitis and infective endocarditis) were ruled out. The diagnosis of PSH was made and started on propranolol along with clonidine. Child responded well to the treatment. Conclusion The complex pathophysiology of PSH warrants extensive work-up to rule out other common causes. The outcome of our patient shows the importance of early diagnosis and multidisciplinary treatment for better outcome.https://doi.org/10.1186/s43054-023-00184-9Paroxysmal sympathetic hyperactivityParoxysmal sympathetic hyperactivity assessment measureParoxysmal autonomic instability with dystoniaParoxysmal sympathetic storms |
| spellingShingle | Jay Bhagwat Jomalkar Vineetha Vijayan Avanti Rajendra Saoji Abhinaya Vaidyanathan Praveen Unki Santosh Kondekar Surbhi Rathi Chandrahas T. Deshmukh Paroxysmal sympathetic hyperactivity in a child with stroke: a case report Egyptian Pediatric Association Gazette Paroxysmal sympathetic hyperactivity Paroxysmal sympathetic hyperactivity assessment measure Paroxysmal autonomic instability with dystonia Paroxysmal sympathetic storms |
| title | Paroxysmal sympathetic hyperactivity in a child with stroke: a case report |
| title_full | Paroxysmal sympathetic hyperactivity in a child with stroke: a case report |
| title_fullStr | Paroxysmal sympathetic hyperactivity in a child with stroke: a case report |
| title_full_unstemmed | Paroxysmal sympathetic hyperactivity in a child with stroke: a case report |
| title_short | Paroxysmal sympathetic hyperactivity in a child with stroke: a case report |
| title_sort | paroxysmal sympathetic hyperactivity in a child with stroke a case report |
| topic | Paroxysmal sympathetic hyperactivity Paroxysmal sympathetic hyperactivity assessment measure Paroxysmal autonomic instability with dystonia Paroxysmal sympathetic storms |
| url | https://doi.org/10.1186/s43054-023-00184-9 |
| work_keys_str_mv | AT jaybhagwatjomalkar paroxysmalsympathetichyperactivityinachildwithstrokeacasereport AT vineethavijayan paroxysmalsympathetichyperactivityinachildwithstrokeacasereport AT avantirajendrasaoji paroxysmalsympathetichyperactivityinachildwithstrokeacasereport AT abhinayavaidyanathan paroxysmalsympathetichyperactivityinachildwithstrokeacasereport AT praveenunki paroxysmalsympathetichyperactivityinachildwithstrokeacasereport AT santoshkondekar paroxysmalsympathetichyperactivityinachildwithstrokeacasereport AT surbhirathi paroxysmalsympathetichyperactivityinachildwithstrokeacasereport AT chandrahastdeshmukh paroxysmalsympathetichyperactivityinachildwithstrokeacasereport |