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March 3, 2022The Egyptian Journal of Neurosurgery : the official publication of the Egyptian Society of Neurological Surgeons/Egyptian journal of neurosurgeryOpen Access

Paroxysmal sympathetic hyperactivity following acute diffuse brain swelling due to traumatic brain injury: a case report with good clinical outcome

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Population

18-year-old man with traumatic brain injury, cerebral herniation due to diffuse brain edema in the left…

Design

Case_report

Follow-up

32 days postsurgery and beyond

Key result

Multimodal treatment, including decompressive craniotomy and multidisciplinary pharmacological management, led to full recovery from paroxysmal sympathetic hyperactivity following severe traumatic brain injury.

Authors

KSKyohei SakaiTKTakehiro KitagawaKSKohei Suzuki

Discussion

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Overview

May inform PSH management after severe TBI; leaves open efficacy confirmation in prospective trials.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P
Population
An 18-year-old man who developed paroxysmal sympathetic hyperactivity following acute diffuse brain swelling due to traumatic brain injury.
I
Intervention
Emergency decompressive craniotomy and internal decompression, followed by anti-edema therapy (glycerol and mannitol) and multimodal medical treatment for PSH (vecuronium, fentanyl, morphine, propofol, dexmedetomidine, and a calcium channel blocker)
O
Outcome
Clinical recovery from PSH and brain edema

Early identification and multimodal management, including decompressive craniotomy and medical therapy, can reverse paroxysmal sympathetic hyperactivity following traumatic brain injury.

Limitations

  • Could not measure serum catecholamine levels
  • Could not monitor intracranial pressure
  • Could not perform magnetic resonance imaging
  • Cranial CT has limitations in detecting non-hemorrhagic lesions and those located in the posterior cranial fossa

Cite This Study

Sakai et al. (2022) conducted a case report in Paroxysmal sympathetic hyperactivity following traumatic brain injury (n=1). Multimodal treatment including decompressive craniotomy and pharmacological management was evaluated on Clinical recovery. Multimodal treatment, including decompressive craniotomy and multidisciplinary pharmacological management, led to full recovery from paroxysmal sympathetic hyperactivity following severe traumatic brain injury.

synapsesocial.com/papers/6aaca7dff3f3e14d29258de9https://doi.org/10.1186/s41984-022-00146-0
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