Akademik Veri Yönetim Sistemi
Turkish Society of Intensive Care (TYBD), 24th International Intensive Care Symposium 5 - 6 May 2023 - Istanbul, İstanbul, Türkiye, 5 - 06 Mayıs 2023, cilt.21, sa.1, ss.138
Introduction: Paroxysmal sympathetic hyperactivity (PSH) is an acute and
serious condition that occurs after diffuse and multifocal brain injuries.
It is characterized by fever, tachycardia, hypertension, tachypnea, and
excessive sweating. Early diagnosis and treatment are essential, otherwise
the damage may be permanent and lead to serious complications. We
presented two critical cases with PSH, to emphasize the importance of
early diagnosis.
Cases: Case 1: A 35-year-old woman had cardiopulmonary arrest during in
vitro fertilization and was admitted to the intensive care unit (ICU) with the
diagnosis of hypoxic-ischemic encephalopathy after resuscitation. Diffuse
chronic ischemic changes were detected at magnetic resonance imaging.
Diffuse dystonic contractions, fever, tachycardia, tachypnea and excessive
sweating were observed. Seizure activity and infection were observed.
Despite administration of paracetamol, hydration and sedation, the
symptoms did not regress. Electroencephalography showed epileptiform
activity. The frequency of attacks could not be reduced. After sedation and
propranolol treatment, the frequency of attacks decreased. Case 2: Twenty
three-year-old patient was admitted to the ICU after a traffic accident
with traumatic brain injury, cerebral edema, subarachnoid hemorrhage,
maxillofacial injury and extremity fractures. He had dystonic contractions,
hypertension, tachycardia, sweating and fever attacks in the ICU. These
symptoms were considered as a septic attack, cultures were taken and
antibiotic treatment was started. However the symptoms persisted, EEG
was performed and moderate-severe cerebral dysfunction was detected.
Brain MRI was consistent with early subacute diffuse axonal damage. After
propranolol and gabapentin were added, the attacks disappeared.
Discussion: PSH can be seen in patients with traumatic-hypoxic brain
injury. It is manifested by recurrent episodes of tachycardia, hypertension,
tachypnea, fever, exaggerated sweating and dystonic posture in patients
with severe brain damage. PSH treatment include sedatives, beta blocker,
and gabapentin. With early diagnosis of this disease, permanent damage
and unnecessary treatments can be prevented.
Keywords: Intensive care, paroxysmal sympathetic hyperactivity, diagnose