Paroxysmal Autonomic Instability with Dystonia after Pneumococcal Meningoencephalitis

Safadieh, Layal; Sharara‐Chami, Rana; Dabbagh, Omar

doi:10.1155/2012/965932

Cited by 14 publications

(8 citation statements)

References 12 publications

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“…Therefore, we did not perform MRI of the spine. One case of autonomic dysfunction after pneumococcal meningoencephalitis has been reported (10). In the present case, transient dysfunction of the sacral segments of the autonomic nervous system might have occurred.…”

Section: Discussionmentioning

confidence: 50%

<i>Streptococcus pneumoniae</i> Meningitis Presenting with Acute Urinary Retention and Emphysematous Cystitis

et al. 2016

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A combination of acute urinary retention and aseptic meningitis has occasionally been described, which is referred to as meningitis-retention syndrome. In contrast, acute urinary retention has rarely been reported in bacterial meningitis. We herein report a case of Streptococcus pneumoniae meningitis presenting with acute urinary retention which led to emphysematous cystitis in an elderly woman. She presented with impaired consciousness and a distended lower abdomen. She was diagnosed with pneumococcal meningitis by lumbar puncture. Abdominal computed tomography revealed the presence of emphysematous cystitis. She completely recovered with antibiotic therapy without any complications. Acute urinary retention can occur secondary to pneumococcal meningitis.

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Section: Discussionmentioning

confidence: 50%

<i>Streptococcus pneumoniae</i> Meningitis Presenting with Acute Urinary Retention and Emphysematous Cystitis

et al. 2016

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“…PAID mostly presents in patients with a single severe brain injury due to trauma or hypoxic events, occurring within 1 month after the underlying brain injury. [ 3 4 5 6 7 8 13 ] In our study, the patient's PAID occurred 3 months after the most recent ischemic stroke and coincided with severe injury of the brain astrocytoma and 2 occurrences of ischemic stroke. β-blockers (propranolol), bromocriptine, and clonazepam were administered to the patient, but the sympathetic storms continued.…”

Section: Discussionmentioning

confidence: 51%

“…[ 1 2 ] According to a previous study on this sympathetic hyperactivity, the incidence ranges from 8% to 33%, depending on underlying brain damage: traumatic brain injury (79.4%), hypoxic brain injury (9.7%), cerebrovascular disorder (5.4%), hydrocephalus (2.6%), tumor (0.6%), and infectious brain injury (0.3%). [ 1 2 3 4 5 6 7 8 ] The mechanism of PAID has been known to be disconnection of the cortical inhibitory center or imbalance between brain excitation and inhibition. [ 9 10 ] To prove these mechanisms and the underlying brain pathology, brain diffusion tensor imaging (DTI), which can show the disconnection of cortical, subcortical, and stem lesions, reportedly plays an effective role.…”

Section: Introductionmentioning

confidence: 99%

Transdermal opioid patch in treatment of paroxysmal autonomic instability with dystonia with multiple cerebral insults

2020

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Rationale: Paroxysmal autonomic instability with dystonia (PAID) is an underdiagnosed syndrome that describes a collection of symptoms following diverse cerebral insults, such as traumatic brain injury, hydrocephalus, hemorrhagic stroke, or brain anoxia. It is manifested by systemic high blood pressure, hyperthermia, tachycardia, tachypnea, diaphoresis, intermittent agitation, and certain forms of dystonia. Patient concerns: A semi-comatose 46-year-old man was transferred from the regional rehabilitation hospital with various complaints involving fluctuating vital signs, including uncontrolled hyperthermia, hypertension, tachycardia, and tachypnea, and dystonia in all extremities. The patient underwent brain surgery for astrocytoma in 1996. The patient also had a history of first ischemic stroke on the basal ganglia in 2008 and a second one in the same area in 2017. Diagnosis: The laboratory, electrocardiography, and radiologic findings were normal. Brain imaging indicated an old infarction on the basal ganglia with hydrocephalus. Tractography using diffusion tensor imaging showed discontinuity of multiple tracts, and electrophysiologic tests, such as evoked potentials, displayed an absent response. Based on the dysautonomic symptoms and brain evaluations, the physiatrist diagnosed the patient with PAID. Interventions: Bromocriptine, propranolol, and clonazepam were administered sequentially, but autonomic instability persisted. Then, intravenous opioid was administered, and fluctuations in body temperature, heart rate, and respiratory rate, as well as decerebrate-type dystonia were improved. However, simultaneously, drug-induced severe hypotension developed (systolic blood pressure, 57 mm Hg). Subsequently, a transdermal opioid (fentanyl) patch for PAID was applied once every 3 days. Outcomes: Ultimately, all vital signs and dystonia were managed without further complications, and the patient was discharged. Lessons: A patient diagnosed with PAID following multiple cerebral insults was observed, whose condition was controlled by application of opioid patch rather than by intravenous or oral routes. A transdermal opioid patch, such as fentanyl patch, can thus be effective in the treatment of patients with PAID following multiple cerebral insults.

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“…Similar cases have been seen in patients with traumatic brain injury (TBI), hydrocephalus, brain tumors, cerebrovascular accident, and subarachnoid hemorrhage [ 7 ]. There have been case reports of PSH caused by pneumococcal meningitis [ 8 ] and tuberculous meningitis [ 9 , 10 ]. Like our patient, cardiac arrest and eventual hypoxic brain injury causing PSH has also been described [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Paroxysmal Sympathetic Hyperactivity after Cardiac Arrest in a Young Male

Singh

Arora

Bedi

et al. 2018

Cureus

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Paroxysmal sympathetic hyperactivity (PSH) is a syndrome of an increased sympathetic drive after brain injury. PSH has been previously referred with multiple different names. It is seen most commonly after a traumatic brain injury, but rarely it has been reported after infections, brain malignancies, and brain injury after cardiac arrest. We present a case of a young male who developed PSH after cardiac arrest and will discuss clinical features and various management options.

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Paroxysmal Autonomic Instability with Dystonia after Pneumococcal Meningoencephalitis

Cited by 14 publications

References 12 publications

<i>Streptococcus pneumoniae</i> Meningitis Presenting with Acute Urinary Retention and Emphysematous Cystitis

<i>Streptococcus pneumoniae</i> Meningitis Presenting with Acute Urinary Retention and Emphysematous Cystitis

Transdermal opioid patch in treatment of paroxysmal autonomic instability with dystonia with multiple cerebral insults

Paroxysmal Sympathetic Hyperactivity after Cardiac Arrest in a Young Male

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