Paroxysmal Sympathetic Hyperactivity: Two Case Reports

Paroxysmal sympathetic hyperactivity (PSH) is a syndrome characterized by episodes of hyperthermia, diaphoresis, agitation, dystonia, and increased blood pressure (BP), respiratory rate (RR), and heart rate (HR). Most cases are found after brain injury, although a few cases have had no brain injury. The exact mechanism is still not clear, but PSH can be treated by opioids, gabapentin, benzodiazepines, centrally acting α-agonists, and β-antagonists, bromocriptine, and intrathecal baclofen, instead of anti-epileptics, antibiotics, or antipyretics, in most cases. Delayed diagnosis and management of PSH may increase morbidity and mortality. We present 2 cases and review the literature on PSH. Accurate diagnosis and appropriate treatment can reduce the number of ventilator days and shorten the hospital course, and even improve the clinical outcome. Therefore, the differential diagnosis and management of patients presenting with hyperthermia, dystonia, tachypnea, and tachycardia are very important in daily practice in the intensive care unit.