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Paroxysmal sympathetic hyperactivity in hemispheric intraparenchymal hemorrhage.

Gao B, Pollock JA, Hinson HE - Ann Clin Transl Neurol (2014)

Bottom Line: Three cases meeting criteria for PSH were identified.Our literature review identified six cases of IPH associated with PSH with five cases having subcortical lesion locations, echoing the areas of disruption in our three cases.Prospective investigations of lesion location in patients with IPH and PSH are warranted to test this hypothesis, especially with advanced neuroimaging techniques.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Oregon Health & Science University, Portland, Oregon.

ABSTRACT

Introduction: Paroxysmal sympathetic hyperactivity (PSH) is a hyperadrenergic syndrome that may follow acute brain injury characterized by episodic, hyperadrenergic alterations in vital signs. Identifying commonality in lesion localization in patients with PSH is challenging, but intraparenchymal hemorrhage (IPH) represents a focal injury that might provide insight. We describe a series of patients with IPH that developed PSH, and review the literature.

Methods: Patients with IPH who developed PSH were identified from OHSU hospital records. A literature review was conducted to identify similar cases through PUBMED, OVID, and Google Scholar.

Results: Three cases meeting criteria for PSH were identified. Hemorrhage volume ranged from 70 to 128 mL, and intracranial hemorrhage score ranged from 2 to 3. The laterality of the hemorrhage and significant volume of hemorrhage was similar in each of the patients, specifically all hemorrhages were large, subcortical, and right-sided. A literature search identified six additional cases, half of whom reported a right hemisphere hemorrhage and the majority also had subcortical localization.

Conclusions: Our literature review identified six cases of IPH associated with PSH with five cases having subcortical lesion locations, echoing the areas of disruption in our three cases. On the basis of these observations, we hypothesize that injuries along the pathway from the insular cortex to downstream sympathetic centers may remove tonic inhibition leading to unchecked sympathetic outflow. Prospective investigations of lesion location in patients with IPH and PSH are warranted to test this hypothesis, especially with advanced neuroimaging techniques.

No MeSH data available.


Related in: MedlinePlus

Overlay of cases 1–3 on a single image, with color representations of the overlapping areas of hemorrhage.
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Figure 2: Overlay of cases 1–3 on a single image, with color representations of the overlapping areas of hemorrhage.

Mentions: We present a total of nine cases of IPH producing PSH, three from our institution and six from the literature. While the cases are heterogeneous, some commonalities exist. Where reported, hemorrhages were often large (>60 mL) and with devastating outcomes. The damage frequently involved subcortical structures, and, where reported, occurred with greater frequency on the right (six cases of right hemispheric IPH compared to two cases of left hemispheric IPH). The three cases at our institution all had right hemispheric IPHs located subcortically but rostral to the mesencephalon (Figs. 1, 2).


Paroxysmal sympathetic hyperactivity in hemispheric intraparenchymal hemorrhage.

Gao B, Pollock JA, Hinson HE - Ann Clin Transl Neurol (2014)

Overlay of cases 1–3 on a single image, with color representations of the overlapping areas of hemorrhage.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4043289&req=5

Figure 2: Overlay of cases 1–3 on a single image, with color representations of the overlapping areas of hemorrhage.
Mentions: We present a total of nine cases of IPH producing PSH, three from our institution and six from the literature. While the cases are heterogeneous, some commonalities exist. Where reported, hemorrhages were often large (>60 mL) and with devastating outcomes. The damage frequently involved subcortical structures, and, where reported, occurred with greater frequency on the right (six cases of right hemispheric IPH compared to two cases of left hemispheric IPH). The three cases at our institution all had right hemispheric IPHs located subcortically but rostral to the mesencephalon (Figs. 1, 2).

Bottom Line: Three cases meeting criteria for PSH were identified.Our literature review identified six cases of IPH associated with PSH with five cases having subcortical lesion locations, echoing the areas of disruption in our three cases.Prospective investigations of lesion location in patients with IPH and PSH are warranted to test this hypothesis, especially with advanced neuroimaging techniques.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Oregon Health & Science University, Portland, Oregon.

ABSTRACT

Introduction: Paroxysmal sympathetic hyperactivity (PSH) is a hyperadrenergic syndrome that may follow acute brain injury characterized by episodic, hyperadrenergic alterations in vital signs. Identifying commonality in lesion localization in patients with PSH is challenging, but intraparenchymal hemorrhage (IPH) represents a focal injury that might provide insight. We describe a series of patients with IPH that developed PSH, and review the literature.

Methods: Patients with IPH who developed PSH were identified from OHSU hospital records. A literature review was conducted to identify similar cases through PUBMED, OVID, and Google Scholar.

Results: Three cases meeting criteria for PSH were identified. Hemorrhage volume ranged from 70 to 128 mL, and intracranial hemorrhage score ranged from 2 to 3. The laterality of the hemorrhage and significant volume of hemorrhage was similar in each of the patients, specifically all hemorrhages were large, subcortical, and right-sided. A literature search identified six additional cases, half of whom reported a right hemisphere hemorrhage and the majority also had subcortical localization.

Conclusions: Our literature review identified six cases of IPH associated with PSH with five cases having subcortical lesion locations, echoing the areas of disruption in our three cases. On the basis of these observations, we hypothesize that injuries along the pathway from the insular cortex to downstream sympathetic centers may remove tonic inhibition leading to unchecked sympathetic outflow. Prospective investigations of lesion location in patients with IPH and PSH are warranted to test this hypothesis, especially with advanced neuroimaging techniques.

No MeSH data available.


Related in: MedlinePlus