Introduction. Paroxysmal sympathetic hyperactivity (PSH) can occur as a result of brain injury, hypoxic brain damage, acute cerebrovascular accident (ACVA). The clinical picture of PSH is caused by excessive sympathetic activity and includes transient paroxysms of tachycardia, hypertension, hyperventilation, hyperthermia, and diaphoresis. PSH is a neurological emergency, which in the vast majority of cases is a diagnosis of exclusion. Lack of adequate detection and treatment of the disease leads to a high mortality rate. The diagnosis is exclusively clinical, so other pathologies must be excluded. Currently, the most widely accepted diagnostic criteria for PSH are the criteria proposed by Baguley et al. Case description. Patient D., 29 years old, was hospitalized with a diagnosis of middle cerebral artery stroke. The patient had attacks which were characterized by tachycardia, hypertension, tachypnea with asynchrony with the ventilator, diaphoresis and hypertension every day with a frequency of 2-3 times per day and were ending approximately 30-40 minutes after the onset. The diagnosis of PSH was established according to the score on the scale proposed by Baguley et al., 25 points (17 or more points – a probable diagnosis of PSH). Conclusions. It is believed that the cause of PSH is a violation of the inhibition function of the cortex on the brain structures located below, as a result of which paroxysms of sympathetic activation occur, manifested by tachycardia, hypertension, hyperventilation, diaphoresis, and hyperthermia. In this clinical case, resolution of paroxysms was observed faster with the combination of morphine and propofol. An important aspect of therapy is adequate rehydration therapy to compensate for fluid losses due to hyperthermia and diaphoresis, as well as the administration of beta-blockers on an ongoing basis

In Ukraine, more than 3.5 million cases of COVID-19 have been registered during the pandemic, and the death toll is almost 90,000. Ukraine is a leader in Europe in the growth of new cases of COVID-19 and mortality from this disease. The search for effective treatment regimens and new approaches to the management of patients with coronavirus disease in order to reduce the severity of coronavirus disease, reduce mortality, the number of complications and improve the rehabilitation period is very important nowadays. The aim of the work. To determine the main causes of mortality in patients with severe COVID-19 by analyzing the frequency and structure of complications in deceased patients. Materials and methods. The study conducted a retrospective analysis of 122 medical charts of deceased patients with COVID-19 who were hospitalized in a communal non-profit enterprise “Kyiv city clinical hospital №17” for the period from September 2020 to November 2021. Results and discussion. The overall mortality among patients with COVID-19 was 9.3%, in the intensive care unit (ICU) – 48.4%. The most common causes of death in patients with COVID-19 were: respiratory failure (RF) – 100% of cases, pulmonary embolism (PE) and acute heart failure (AHF) - about 60%. The average length of stay of patients in inpatient treatment was 11.67 ± 8.05 days, and in the intensive care unit – 7.94 ± 6.24 days. The mean age of patients hospitalized in the ICU was 63.5 ± 12.9 years and the mean age of patients who died was 71.2 ± 10.29 years. Prognostically significant criteria for lethal consequences were the presence of comorbidity: cardiovascular diseases- 92.3%, endocrine system diseases – 28.4%, nervous system diseases – 23.07%, kidney diseases – 9.6%, cancer – 9,6%, autoimmune conditions – 7.69%, varicose veins – 5.7%, respiratory system diseases – 5.7%. In patients with fatal outcome lymphopenia (84.6%) was observed in patients on admission to the ICU. Vasopressor and inotropic support was performed in 50 % of patients with COVID-19. In 25 % of those who died during long-term treatment and long-term respiratory support, there was the development of multiple organ failure, which in most cases was the point of no return. Conclusions. The most common causes of death were: respiratory failure, thrombosis, acute cardiovascular failure, sepsis and multiple organ failure. The main nature of the complications is common, but the cohort may be affected by different factors and the percentage of complications may differ in other hospitals.