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July 23, 2025CureusOpen Access

Multimodal therapy with bromocriptine, baclofen, and clobazam achieved partial control of sympathetic storms in a 50-year-old male with paroxysmal sympathetic hyperactivity after pontine hemorrhage.

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Why the study?

Paroxysmal sympathetic hyperactivity is a rare, under-recognized complication of intracerebral hemorrhage with poorly understood pathophysiology and no standardized diagnostic or treatment guidelines.

Population

One 50-year-old male with spontaneous pontine ICH who developed PSH

Design

Case report

Key result

Multimodal therapy with bromocriptine, baclofen, and clobazam achieved partial control of sympathetic storms in a 50-year-old male with paroxysmal sympathetic hyperactivity after pontine hemorrhage.

Authors

YLYu Tung LoVNVincent Diong Weng Nga

Discussion

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Member takes

Overview

May inform refractory PSH management; leaves open need for controlled trials.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P
Population
A 50-year-old male with spontaneous pontine intracerebral hemorrhage who developed paroxysmal sympathetic hyperactivity complicated by rhabdomyolysis and acute kidney injury.
I
Intervention
Multimodal therapy with bromocriptine (up to 5 mg orally every 8 hours), baclofen (up to 10 mg orally every 8 hours), and clobazam (up to 10 mg twice daily).
O
Outcome
Clinical course and resolution of autonomic episodes

This case highlights the diagnostic and therapeutic challenges of paroxysmal sympathetic hyperactivity following spontaneous pontine hemorrhage, emphasizing the need for early recognition and multimodal therapy to prevent complications like rhabdomyolysis.

Limitations

  • Single case report limits generalizability
  • Lack of standardized diagnostic criteria and evidence-based treatment protocols for PSH
  • Autonomic testing modalities were not pursued due to acute ICU setting constraints

Cite This Study

Lo et al. (2025) conducted a case report in Paroxysmal sympathetic hyperactivity following spontaneous pontine hemorrhage (n=1). Multimodal therapy (bromocriptine, baclofen, and clobazam) was evaluated on Control of sympathetic storms. Multimodal therapy with bromocriptine, baclofen, and clobazam achieved partial control of sympathetic storms in a 50-year-old male with paroxysmal sympathetic hyperactivity after pontine hemorrhage.

synapsesocial.com/papers/6a98262490d51c6c12faf8fchttps://doi.org/10.7759/cureus.88602
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