Paroxysmal autonomic instability with dystonia: Difference between revisions
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==Background== | ==Background== | ||
*Also referred to as PAID syndrome, or paroxysmal sympathetic hyperactivity (PSH) | |||
*Defined as paroxysmal episodes of sympathetic activity in patients with severe brain injury<ref>Baguley IJ, Perkes IE, Fernandez-Ortega JF, Rabinstein AA, Dolce G, Hendricks HT; Consensus Working Group. Paroxysmal sympathetic hyperactivity after acquired brain injury: consensus on conceptual definition, nomenclature, and diagnostic criteria. J Neurotrauma. 2014 Sep 1;31(17):1515-20. doi: 10.1089/neu.2013.3301. Epub 2014 Jul 28. PMID: 24731076.</ref> | |||
*Mechanism remains poorly understood | |||
==Clinical Features== | ==Clinical Features== | ||
*[[Tachycardia]] | |||
*[[Hypertension]] | |||
**Repeat episodes pose risk for [[hypertensive emergency]] | |||
*[[Tachypnea]] | |||
*[[Hyperthermia]] | |||
*Dystonic posturing, typically symmetric | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Hypertension DDX}} | |||
===Other Diagnoses to Consider=== | |||
*[[Pulmonary embolism]] | |||
*[[Sepsis]] | |||
*[[Elevated intracranial pressure]] | |||
*[[Seizure]] | |||
*[[Alcohol withdrawal]] | |||
==Evaluation== | ==Evaluation== | ||
===Workup=== | ===Workup=== | ||
*Labwork/imaging used primarily to rule out other diagnoses as appropriate | |||
===Diagnosis=== | ===Diagnosis=== | ||
*Clinical diagnosis, no confirmatory test | |||
==Management== | ==Management== | ||
*Supportive care | |||
**Reducing stimulation | |||
**Treating [[hyperthermia]] | |||
*Pharmacologic therapy: Aimed at attenuating sympathetic activity | |||
**[[Morphine]] | |||
**[[Gabapentin]] | |||
**Noncardioselective [[beta blocker]] | |||
**+/-[[Clonidine]] | |||
==Disposition== | ==Disposition== | ||
| Line 27: | Line 50: | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Cardiology]] | |||
[[Category:Neurology]] | |||
Latest revision as of 17:18, 1 March 2023
Background
- Also referred to as PAID syndrome, or paroxysmal sympathetic hyperactivity (PSH)
- Defined as paroxysmal episodes of sympathetic activity in patients with severe brain injury[1]
- Mechanism remains poorly understood
Clinical Features
- Tachycardia
- Hypertension
- Repeat episodes pose risk for hypertensive emergency
- Tachypnea
- Hyperthermia
- Dystonic posturing, typically symmetric
Differential Diagnosis
Hypertension
- Hypertensive emergency
- Stroke
- Sympathetic crashing acute pulmonary edema
- Ischemic stroke
- Intracranial hemorrhage
- Preeclampsia/Eclampsia
- Autonomic dysreflexia
- Scleroderma renal crisis
- Acute glomerulonephritis
- Type- I myocardial infarction
- Volume overload
- Urinary obstruction
- Drug use or overdose (e.g stimulants, especially alcohol, cocaine, or Synthroid)
- Renal Artery Stenosis
- Nephritic and nephrotic syndrome
- Polycystic kidney disease
- Tyramine reaction
- Cushing's syndrome
- Obstructive sleep apnea
- Pheochromocytoma
- Hyperaldosteronism
- Hyperthyroidism
- Anxiety
- Pain
- Oral contraceptive use
Other Diagnoses to Consider
Evaluation
Workup
- Labwork/imaging used primarily to rule out other diagnoses as appropriate
Diagnosis
- Clinical diagnosis, no confirmatory test
Management
- Supportive care
- Reducing stimulation
- Treating hyperthermia
- Pharmacologic therapy: Aimed at attenuating sympathetic activity
- Morphine
- Gabapentin
- Noncardioselective beta blocker
- +/-Clonidine
Disposition
See Also
External Links
References
- ↑ Baguley IJ, Perkes IE, Fernandez-Ortega JF, Rabinstein AA, Dolce G, Hendricks HT; Consensus Working Group. Paroxysmal sympathetic hyperactivity after acquired brain injury: consensus on conceptual definition, nomenclature, and diagnostic criteria. J Neurotrauma. 2014 Sep 1;31(17):1515-20. doi: 10.1089/neu.2013.3301. Epub 2014 Jul 28. PMID: 24731076.