A Case of Paroxysmal Sympathetic Hyperactivity due to Cardiogenic Shock

Paroxysmal sympathetic hyperactivity (PSH) is characterized by excessive autonomic activation typically seen after severe brain injury. PSH has not previously been reported in association with cardiogenic shock. Here, we report a case of PSH during the treatment of cardiogenic shock with dilated cardiomyopathy.

A 60-year-old man with cardiogenic shock and dilated cardiomyopathy was transferred to our hospital. He was intubated and received an Impella support. On Day 4 post-admission, paroxysmal fever, tachycardia, tachypnea, and abnormal muscle tone were observed in the extremities. Antiepileptic drugs and broad-spectrum antibiotics were ineffective, and the seizure pattern suggested PSH; therefore, gabapentin was started on Day 27 post-admission. The seizures gradually resolved and eventually resolved.

This case suggests that PSH may be triggered by functional disturbances in cerebral perfusion and autonomic regulation associated with cardiogenic shock, even in the absence of irreversible brain injury. When patients with cardiogenic shock present with paroxysmal tachycardia, tachypnea, and fever, PSH should be considered in the differential diagnosis. Early recognition of PSH may facilitate timely treatment and contribute to improved clinical outcomes.