Abstract
Severe paroxysmal sympathetic overactivity occurs in a subgroup of patients with acquired brain injuries including traumatic brain injury, hypoxia, infection and tumor-related complications. This condition is characterized by sudden increase of heart rate, respiratory rate, blood pressure, body temperature and excessive diaphoresis. The episodes may be induced by external stimulation or may occur spontaneously. Frequent occurrence of this condition could result in secondary morbidities, therefore, should be diagnosed and managed insightfully. These symptoms could be confused with seizures or other medical conditions, leading to unnecessary treatment. Despite clinical significance of paroxysmal sympathetic hyperactivity (PSH), brain tumor-induced PSH has not been studied nearly. In this report, two cases of the PSH in patients with brainstem-compressing benign tumors were introduced. The most useful pharmacologic agents were opioid (e.g., fentanyl patch) in preventing PSH attack, and nonselective β-blocker (e.g., propranolol) in relieving the symptoms. Clinical experiences of the rare cases of benign tumor-induced PSH can be helpful as an essential basis for further research.
Keywords: Brain tumor; Brainstem; Opioid; Paroxysmal sympathetic hyperactivity.
a. Preoperative radiologic imaging of patient 1 with PSH. Huge size (8.1 cm) extraaxial calcified mass over left middle cranial fossa and posterior cranial fossa is compressing brainstem. This mass originates from petrosal apex and displaces midbrain, pons, and middle cerebellar peduncle to right side. (Clockwise direction; T2WI coronal, T1W enhance coronal, CT with enhance, T1W enhance axial). b. Postoperative (POD 20) CT scan showing residual calcified mass adjacent to brainstem and hemorrhage, edema in brainstem
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