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Kapoor D, Singla D, Singh J, Jindal R
Correspondence: Dr Dheeraj Kapoor, kapoor.dheeraj72@gmail.com
ABSTRACT
Paroxysmal autonomic instability with dystonia (PAID) appears to be a unique syndrome following brain injury. It can echo many life-threatening conditions, making its early recognition and management a challenge for intensivists. A delay in early recognition and subsequent management may result in increased morbidity, which is preventable in affected patients. Herein, we report the case of a patient who was diagnosed with PAID syndrome following prolonged cardiac arrest, and discuss the pathophysiology, clinical presentation and management of this rare and under-recognised clinical entity.
Keywords: autonomic nervous system, brain injury, cardiac arrest, diffuse axonal injury, paroxysmal autonomic instability with dystonia
Singapore Med J 2014; 55(8): e123-e125; http://dx.doi.org/10.11622/smedj.2013264
REFERENCES
| 1. Baguley IJ, Nicholls JL, Felmingham KL, et al. Dysautonomia after traumatic brain injury: a forgotten syndrome? J Neurol Neurosurg Psychiatry 1999; 67:39-43. http://dx.doi.org/10.1136/jnnp.67.1.39 | ||||
| 2. Blackman JA, Patrick PD, Buck ML, Rust RS Jr. Paroxysmal autonomic instability with dystonia after brain injury. Arch Neurol 2004; 61:321-8. http://dx.doi.org/10.1001/archneur.61.3.321 | ||||
| 3. Pranzatelli MR, Pavlakis SG, Gould RJ, De Vivo DC. Hypothalamic-midbrain dysregulation syndrome: hypertension, hyperthermia, hyperventilation, and decoration. J Child Neurol 1991; 6:115-22. http://dx.doi.org/10.1177/088307389100600204 | ||||
| 4. Bulakbasi N, Pabuscu Y, Kurtaran HK, et al. "Results of Acute Cerebral Anoxia in Adults: is it a Reversal Sign?" Turk J Med Sci 2000; 30:571-77. | ||||
| 5. Baguley IJ, Heriseanu RE, Cameron ID, Nott MT, Slewa-Younan S. A critical review of the pathophysiology of dysautonomia following traumatic brain injury. Neurocrit Care 2008; 8:293-300. http://dx.doi.org/10.1007/s12028-007-9021-3 | ||||
| 6. Bullard DE. Diencephalic seizures: responsiveness to bromocriptine and morphine. Ann Neurol 1987; 21:609-11. http://dx.doi.org/10.1002/ana.410210617 | ||||
| 7. Boeve BF, Wijdicks EF, Benarroch EE, Schmidt KD. Paroxysmal sympathetic storms ("diencephalic seizures") after severe diffuse axonal head injury. Mayo Clin Proc 1998; 73:148-52. http://dx.doi.org/10.1016/S0025-6196(11)63647-1 | ||||
| 8. McEvoy GK (Ed). American Hospital Formulary Service Drug Information, American Society of Hospital Pharmacists. Bethesda, 1994:1195-286. | ||||
| 9. Chiolero RL, Breitenstein E, Thorin D. Effects of propranolol on resting metabolic rate after severe head injury. Crit Care Med 1989; 17:328-34. http://dx.doi.org/10.1097/00003246-198904000-00006 | ||||
| 10. Do D, Sheen VL, Bromfield E. Treatment of paroxysmal sympathetic storm with labetalol. J Neurol Neurosurg Psychiatry 2000; 69:832-3. http://dx.doi.org/10.1136/jnnp.69.6.832 | ||||
| 11. Becker R, Benes L, Sure U, Hellwig D, Bertalanffy H. Intrathecal baclofen alleviates autonomic dysfunction in severe brain injury. J Clin Neurosci 2000; 7:316-9. http://dx.doi.org/10.1054/jocn.1999.0227 | ||||
| 12. Baguley IJ, Heriseanu RE, Gurka JA, Nordenbo A, Cameron ID. Gabapentin in the management of dysautonomia following severe traumatic brain injury: a case series. J Neurol Neurosurg Psychiatry 2007; 78:539-41. http://dx.doi.org/10.1136/jnnp.2006.096388 | ||||
| 13. Russo RN, O'Flaherty S. Bromocriptine for the management of autonomic dysfunction after severe traumatic brain injury. J Paediatr Child Health 2000; 36:283-5. http://dx.doi.org/10.1046/j.1440-1754.2000.00485.x | ||||
| 14. Silver JK, Lux WE. Early onset dystonia following traumatic brain injury. Arch Phys Med Rehabil 1994; 75:885-8. http://dx.doi.org/10.1016/0003-9993(94)90113-9 | ||||
| 15. Granato JE, Stern BJ, Ringel A, Karim AH, et al. Neuroleptic malignant syndrome: successful treatment with dantrolene and bromocriptine. Ann Neurol 1983; 14:89-90. http://dx.doi.org/10.1002/ana.410140117 | ||||