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Propranolol for Paroxysmal Sympathetic Hyperactivity with Lateralizing Hyperhidrosis after Stroke.

Jason W Siefferman¹, George Lai²

¹Department of Neurology, VA New York Harbor Healthcare System, 423 East 23rd Street No. 127, New York, NY 10010, USA.

Case Reports in Neurological Medicine

|July 14, 2015

Summary

Stroke can cause sympathetic nervous system overactivation. This case study shows propranolol effectively treated unilateral dysautonomia and central fever following a stroke, highlighting its potential for managing post-stroke sympathetic hyperactivity.

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Area of Science:

Neurology
Cardiovascular Medicine
Neuroscience

Background:

Brain injury, particularly stroke, can disrupt cortical inhibition of the hypothalamus.
This disruption can lead to overactivation of the sympathetic nervous system, a condition known as paroxysmal sympathetic hyperactivity.
Symptoms include fever, rapid heart rate, rapid breathing, vasodilation, and excessive sweating.

Purpose of the Study:

To report a case of unilateral dysautonomia following a stroke.
To investigate the efficacy of propranolol in treating stroke-induced central fever and hyperhidrosis.
To highlight propranolol as a potential treatment for paroxysmal sympathetic hyperactivity.

Main Methods:

A case report of a 41-year-old male patient with a left middle cerebral artery stroke.
Observation of symptoms including central fever, contralateral temperature changes, and hyperhidrosis.
Administration and discontinuation of low-dose propranolol to assess treatment response.

Main Results:

The patient developed unilateral dysautonomia and central fever post-stroke.
Low-dose propranolol effectively alleviated symptoms of central fever and hyperhidrosis.
Symptom recurrence upon propranolol discontinuation and resolution upon re-initiation confirmed its efficacy.

Conclusions:

This case demonstrates the first reported use of propranolol for unilateral dysautonomia after stroke.
Propranolol, a beta-blocker that crosses the blood-brain barrier, shows promise in managing paroxysmal sympathetic hyperactivity.
The findings suggest propranolol as a viable therapeutic option for specific post-stroke autonomic dysfunctions.