RT Book, Section
A1 Samuel, Sophie
A1 Choi, H. Alex
A1 Lee, Kiwon
A2 Lee, Kiwon
SR Print(0)
ID 1143954412
T1 Paroxysmal Sympathetic Hyperactivity
T2 The NeuroICU Book, 2e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9780071841443
LK neurology.mhmedical.com/content.aspx?aid=1143954412
RD 2024/04/20
AB The  patient  is  a  19-year-old  man  who  was  in  a  motor  vehicle  collision  and  was  brought  to  the  emergency  department  for  management  of  traumatic  brain  injury.  On  arrival  he  was  Glasgow  Coma  Scale  (GCS)  of  5.  A  computed  tomography  (CT)  scan  showed  diffuse  cerebral  edema.  An  intracranial  pressure  (ICP)  monitor  was  placed,  and  he  had  aggressive  medical  measures  to  control  ICP.  By  hospital  day  7  his  ICPs  are  under  control.  On  day  14  he  develops  episodes  of  tachycardia,  increased  respiratory  rate,  fever,  diaphoresis,  and  dystonic  posturing  occurring  8  to  10  times  per  day.  Vital  signs  are  temperature,  38.9°C;  heart  rate,  130  bpm;  respiratory  rate,  32  breaths/min;  and  blood  pressure,  180/75  mm  Hg.  Neurological  assessment  is  as  follows:  he  localizes  on  the  left  side  but  is  paretic  on  the  right  side.  GCS  of  10:  eye  3,  verbal  3,  motor  4.  Pupils  are  reactive  to  light,  and  other  brainstem  reflexes  were  intact.  A  CT  of  the  head  shows  no  significant  changes.