[A case of prolonged paroxysmal sympathetic hyperactivity]

Area of Science:

• Pediatric Neurology
• Critical Care Medicine
• Neuropharmacology

Background:

• Paroxysmal sympathetic hyperactivity (PSH) is a rare but severe condition, often following hypoxic-ischemic encephalopathy.
• Prompt diagnosis and effective management are crucial for improving patient outcomes.

Observation:

• A 4-year-old girl with PSH post-cardiopulmonary arrest exhibited significant sympathetic overactivity and dystonia.
• Treatment involved multiple medications, with morphine, bromocriptine, propranolol, and clonidine showing efficacy in reducing attack frequency.

Findings:

• Gabapentin, baclofen, dantrolene, and benzodiazepines were ineffective in managing the patient's PSH symptoms.
• Plasma catecholamine levels correlated with PSH episodes, rising during attacks and normalizing between them.
• Complete control of PSH paroxysms was not achieved, with symptoms persisting beyond 500 days.

Implications:

• This case highlights the challenges in pediatric PSH management and the differential drug responses observed.
• Understanding plasma catecholamine fluctuations provides insights into PSH pathophysiology.
• Further case studies are needed to refine treatment strategies and elucidate the underlying mechanisms of PSH.