Paroxysmal sympathetic hyperactivity in tubercular meningitis: An underacknowledged association

Area of Science:

• Neurology
• Infectious Diseases
• Critical Care Medicine

Background:

• Paroxysmal sympathetic hyperactivity (PSH) is typically linked to traumatic brain injury.
• PSH occurrence in central nervous system infections is infrequently reported due to low incidence.
• This case report focuses on PSH secondary to tubercular meningitis (TBM) to underscore disease burden.

Purpose of the Study:

• To document a rare case of PSH in a pediatric patient with TBM.
• To emphasize the diagnostic challenges and management complexities of PSH in CNS infections.
• To highlight the potential severity and morbidity associated with PSH in TBM.

Main Methods:

• A case report of an 11-year-old female diagnosed with TBM.
• The patient underwent ventriculoperitoneal shunt surgery and subsequently developed PSH symptoms.
• Clinical presentation, PSH-Assessment Measure score, and treatment outcomes were documented.

Main Results:

• The patient presented with high-grade fever, diaphoresis, tachycardia, and hypertension post-surgery.
• Despite aggressive management, the patient's condition deteriorated.
• The PSH-Assessment Measure score indicated probable PSH, and the patient ultimately succumbed to the disease.

Conclusions:

• Common PSH manifestations include tachycardia, tachypnea, dystonia, hyperthermia, hypertension, and diaphoresis.
• Early detection and a low threshold for diagnosing PSH are crucial to prevent neurological sequelae.
• This report details the 7th case of PSH in TBM without hydrocephalus and the 15th overall case of PSH in TBM.