Diencephalic Storms From Leptomeningeal Metastases and Leukoencephalopathy

Abstract

Diencephalic storms or paroxysmal sympathetic storms are characterized by episodic hyperhidrosis, hypertension, tachypnea, tachycardia, and abnormal posturing. These have been reported to occur in patients with hydrocephalus, intracranial tumors, and hypoxic, ischemic, or traumatic brain injury. They can be easily misdiagnosed as seizures, uncontrolled pheochromocytoma, drug withdrawal, thyroid storm, hypertensive crises, and sepsis or anxiety attacks. The most effective treatment to control these symptoms is yet to be identified. We present 2 individuals exhibiting these sympathetic surges; one whose symptoms were controlled with phenobarbital and the other with clonidine and oxycodone. Palliative medicine physicians should be made aware of this unusual complication.

Paroxysmal sympathetic hyperactivity in brainstem-compressing huge benign tumors: clinical experiences and literature review

“…Hypermetabolic state during sympathetic storms leads to body weight decrease estimated at 25 % in the acute period alone (Lemke 2007 ). These patients also have an increased likelihood of developing hyperthermia has been found to predict poor outcome, potentially as a direct cause of secondary brain damage (Rabinstein and Benarroch 2008 ; Soriano et al 2014 ). Moreover, the prolonged hypersympathetic tone associated with the PSH could produce or exacerbate cardiac damage and elevated intracranial pressure (Rodriguez et al 2006 ; Tong et al 2000 ).…”