[A case of paroxysmal sympathetic hyperactivity following hypoxic brain injury with ‍difficult treatment]

The patient was a woman in her 20s. In June of a certain year, she experienced cardiopulmonary arrest due to acute epiglottitis and was admitted to the ICU and required mechanical ventilation. From the first day of hospitalization, she exhibited generalized seizures and was diagnosed with acute symptomatic seizures following hypoxic brain injury. Treatment with diazepam and levetiracetam was initiated, leading to symptom resolution. However, around the seventh day of hospitalization, she began experiencing episodic limb muscle hypertonia and fever. Based on diagnostic criteria, she was diagnosed with paroxysmal sympathetic hyperactivity on the 20th day of hospitalization. Although treatment with propranolol, gabapentin, and baclofen was initiated, her symptoms persisted. On the 38th day of hospitalization, morphine hydrochloride and methylprednisolone were administered, resulting in remarkable improvement. The present case shows that accurate diagnosis of paroxysmal sympathetic hyperactivity following hypoxic brain injury, particularly its differentiation from acute symptomatic seizures, is essential for appropriate management.