A case of paroxysmal sympathetic hyperactivity following cerebral infarction due to basilar artery dissection

Paroxysmal sympathetic hyperactivity (PSH) is a syndrome characterized by episodic tachycardia, tachypnea, hypertension, fever, sweating, pupillary dilatation, and dystonic postures. Traumatic brain injury is the leading cause of PSH; however, its occurrence following basilar artery (BA) dissection has not been reported.

A previously healthy 23-year-old man was found unresponsive and was transported with a Glasgow Coma Scale score of 11. Imaging studies revealed an acute ischemic stroke attributable to BA dissection. Magnetic resonance imaging showed progressive lesions involving the bilateral thalami, occipital lobes, cerebellar hemispheres, vermis, midbrain, pons, and periaqueductal gray. On the 8th day after admission, he developed PSH symptoms, which subsided after medical treatment.

A case of PSH following BA dissociation is reported. The ischemic lesions presented here indicate the essential anatomical location causing PSH. Early treatment is warranted, recognizing that PSH could be an adverse event following BA dissection.