Paroxysmal autonomic instability with dystonia: Difference between revisions
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Hypertension DDX}} | |||
===Other Diagnoses to Consider=== | |||
*[[Pulmonary embolism]] | *[[Pulmonary embolism]] | ||
*[[Sepsis]] | *[[Sepsis]] | ||
Revision as of 23:44, 15 December 2022
Background
- Also referred to as PAID syndrome, or paroxysmal sympathetic hyperactivity (PSH)
- Defined as paroxysmal episodes of sympathetic activity in patients with severe brain injury[1]
- Mechanism remains poorly understood
Clinical Features
- Tachycardia
- Hypertension
- Repeat episodes pose risk for hypertensive emergency
- Tachypnea
- Hyperthermia
- Dystonic posturing, typically symmetric
Differential Diagnosis
Hypertension
- Hypertensive emergency
- Stroke
- Sympathetic crashing acute pulmonary edema
- Ischemic stroke
- Intracranial hemorrhage
- Preeclampsia/Eclampsia
- Autonomic dysreflexia
- Scleroderma renal crisis
- Acute glomerulonephritis
- Type- I myocardial infarction
- Volume overload
- Urinary obstruction
- Drug use or overdose (e.g stimulants, especially alcohol, cocaine, or Synthroid)
- Renal Artery Stenosis
- Nephritic and nephrotic syndrome
- Polycystic kidney disease
- Tyramine reaction
- Cushing's syndrome
- Obstructive sleep apnea
- Pheochromocytoma
- Hyperaldosteronism
- Hyperthyroidism
- Anxiety
- Pain
- Oral contraceptive use
Other Diagnoses to Consider
Evaluation
Workup
Diagnosis
- Clinical diagnosis
Management
- Supportive care
- Reducing stimulation
- Treating hyperthermia
- Pharmacologic therapy: Aimed at attenuating sympathetic activity
- Morphine
- Gabapentin
- Noncardioselective beta blocker
- +/-Clonidine
Disposition
See Also
External Links
References
- ↑ Baguley IJ, Perkes IE, Fernandez-Ortega JF, Rabinstein AA, Dolce G, Hendricks HT; Consensus Working Group. Paroxysmal sympathetic hyperactivity after acquired brain injury: consensus on conceptual definition, nomenclature, and diagnostic criteria. J Neurotrauma. 2014 Sep 1;31(17):1515-20. doi: 10.1089/neu.2013.3301. Epub 2014 Jul 28. PMID: 24731076.