Susceptibility weighted imaging in a patient with paroxysmal sympathetic storms

Huang, Poyin; Lin, Wei‐Chen; Huang, Po-Kai; Khor, Gim-Thean

doi:10.1007/s00415-009-0957-4

Cited by 11 publications

(3 citation statements)

References 7 publications

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“…Susceptibility weighted imaging (SWI) has gradually developed into a useful clinical tool in the field of cerebrovascular diseases [1][2][3][4][5]. It has been applied widely, including for detection of intracerebral hemorrhage, hemorrhagic transformation, cerebral venous thrombosis and assessment of brain tissue at risk for infarction [6].…”

Section: Introductionmentioning

confidence: 99%

Clinical applications of susceptibility weighted imaging in patients with major stroke

et al. 2011

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Susceptibility weighted imaging (SWI) is a newly developed magnetic resonance (MR) protocol. Recent studies have found that SWI may be useful in the field of cerebrovascular diseases, especially for detecting the presence of prominent veins, microbleeds and the susceptibility vessel sign (SVS). Some authors have even suggested that SWI can be used to predict outcome. We conducted a prospective study of patients hospitalized with middle cerebral artery territory infarction receiving MRI within 2 days of stroke onset. The presence of prominent veins, microbleeds and SVS in SWI was analyzed along with hospital characteristics of the patients. A total of 44 patients were enrolled. Among the 44 patients, 15 (34.1%) patients showed prominent veins, 19 (43.2%) showed SVS, and 14 (31.8%) showed microbleeds. The presence of SVS and prominent veins was not associated with prognosis. Though not statistically significant (p = 0.06), patients with SVS were more likely to develop later brain edema. SVS was significantly associated with arterial occlusion (p = 0.008) based on the MR angiogram, and microbleeds were significantly associated with later hemorrhagic transformation (p = 0.018). In our study, SWI could not be used to predict outcome as previously suggested. However, the presence of microbleeds may predict further hemorrhagic transformation, and the presence of SVS could be used to detect intra-arterial thrombus. Patients with SVS were also more likely to develop later brain edema. Including SWI in routine MR protocols for major acute ischemic stroke would be worthwhile.

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Section: Introductionmentioning

confidence: 99%

Clinical applications of susceptibility weighted imaging in patients with major stroke

et al. 2011

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“…Instead, global, diffuse or multifocal cerebral injury is typically present. Neuroimaging studies have noted the association of PSH with diffuse axonal injury 14,19 and injuries affecting the periventricular white matter, corpus callosum, diencephalon, and upper brain stem. 20,21 Studies employing diffusion tensor imaging magnetic resonance imaging have shown that PSH is more common when there is disconnection of the white matter tracts involving the posterior corpus callosum and posterior limb of the internal capsule.…”

Section: Pathophysiologymentioning

confidence: 99%

Paroxysmal Sympathetic Hyperactivity

Scott

Rabinstein

2020

Semin Neurol

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Paroxysmal sympathetic hyperactivity (PSH) is a relatively common, but often unrecognized, complication of acute diffuse or multifocal brain diseases, most frequently encountered in young comatose patients with severe traumatic brain injury. It is presumed to be caused by loss of cortical inhibitory modulation of diencephalic and brain stem centers and possible additional maladaptive changes in the spinal cord that combine to produce exaggerated sympathetic responses to stimulation. The syndrome consists of repeated sudden episodes of tachycardia, tachypnea, hypertension, sweating, and sometimes fever and dystonic posturing. The diagnosis is clinical. Treatment includes reducing any external stimulation that can trigger the episodes, and starting abortive (e.g., intravenous morphine) and preventive medications (e.g., gabapentin, propranolol, clonidine). Prompt and adequate treatment of PSH may reduce the likelihood of secondary complications, such as dehydration, weight loss and malnutrition, and muscle contractures.

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“…In contrast, Boeve et al [6] reported on a traumatic injury patient without definite structural lesions in the hypothalamus or brainstem. Huang et al [16] differentiated PPS from fat embolism syndrome in traumatic injury patients by identifying diffuse axonal injury using susceptibility-weighted MRI. Our case revealed an intracerebral hematoma in the right basal ganglia.…”

Section: Discussionmentioning

confidence: 99%

A Unique Pattern of Intracranial Pressure in a Patient with Traumatic Paroxysmal Sympathetic Storm

Woo¹,

Park²,

Hwang³

2010

Pediatr Neurosurg

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Paroxysmal sympathetic storm (PSS), or diencephalic seizure, usually appears in patients with severe traumatic brain injury and is characterized by various sympathetic symptoms. The physiological effects of this syndrome are not well studied. The authors monitored intracranial pressure (ICP) in a patient with PSS and reviewed its impact on the physiology and management of the syndrome. A 12-year-old male patient was involved in a traffic accident. Upon arrival at the emergency room, his Glasgow Coma Scale score was 5 and he showed decerebration. A brain CT showed an intracerebral hematoma in the right basal ganglia, at which point craniotomy and removal of the hematoma were performed. Continuous intracranial monitoring was performed using the fiber-optic intraparenchymal method. Beginning the day after the trauma, the patient began exhibiting sympathetic symptoms including intermittent episodes of fever, tachycardia, increased blood pressure, tachypnea, diaphoresis and decerebrate rigidity. These episodes were accompanied by ICP elevation of greater than 20 mm Hg. ICP was decreased during hyperventilation, and the episodic symptoms subsided as ICP normalized. PaCO₂ was periodically altered in association with hyperventilation. Electroencephalogram did not show epileptiform discharges, and the sympathetic spells were aborted by continuous intravenous midazolam infusion. The authors report on a pattern of ICP monitoring in association with PSS. Traumatic PSS should be recognized in the appropriate setting to prevent secondary brain damage.

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Susceptibility weighted imaging in a patient with paroxysmal sympathetic storms

Cited by 11 publications

References 7 publications

Clinical applications of susceptibility weighted imaging in patients with major stroke

Clinical applications of susceptibility weighted imaging in patients with major stroke

Paroxysmal Sympathetic Hyperactivity

A Unique Pattern of Intracranial Pressure in a Patient with Traumatic Paroxysmal Sympathetic Storm

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