Godoy Daniel Agustin, Orquera Jose, Rabinstein Alejandro A
Unidade de Terapia Neurointensiva, Sanatório Pasteur - Catamarca, Argentina.
Unidade de Terapia Intensiva, Hospital San Juan Bautista - Catamarca, Argentina.
Rev Bras Ter Intensiva. 2018 Apr-Jun;30(2):237-243. doi: 10.5935/0103-507X.20180035.
Paroxysmal sympathetic hyperactivity represents an uncommon and potentially life-threatening complication of severe brain injuries, which are most commonly traumatic. This syndrome is a clinical diagnosis based on the recurrent occurrence of tachycardia, hypertension, diaphoresis, tachypnea, and occasionally high fever and dystonic postures. The episodes may be induced by stimulation or may occur spontaneously. Underdiagnosis is common, and delayed recognition may increase morbidity and long-term disability. Trigger avoidance and pharmacological therapy can be very successful in controlling this complication. Fat embolism syndrome is a rare but serious complication of long bone fractures. Neurologic signs, petechial hemorrhages and acute respiratory failure constitute the characteristic presenting triad. The term cerebral fat embolism is used when the neurological involvement predominates. The diagnosis is clinical, but specific neuroimaging findings can be supportive. The neurologic manifestations include different degrees of alteration of consciousness, focal deficits or seizures. Management is supportive, but good outcomes are possible even in cases with very severe presentation. We report two cases of paroxysmal sympathetic hyperactivity after cerebral fat embolism, which is a very uncommon association.
阵发性交感神经过度兴奋是重度脑损伤（最常见为创伤性脑损伤）的一种罕见且可能危及生命的并发症。该综合征是一种基于心动过速、高血压、出汗、呼吸急促，偶尔伴有高热和肌张力障碍姿势反复出现的临床诊断。发作可能由刺激诱发或自发发生。漏诊很常见，延迟识别可能会增加发病率和长期残疾率。避免触发因素和药物治疗在控制这种并发症方面可能非常成功。脂肪栓塞综合征是长骨骨折的一种罕见但严重的并发症。神经体征、瘀点出血和急性呼吸衰竭构成其典型的三联征表现。当以神经受累为主时，使用脑脂肪栓塞这一术语。诊断主要依靠临床，但特定的神经影像学检查结果可提供支持。神经表现包括不同程度的意识改变、局灶性缺损或癫痫发作。治疗以支持治疗为主，即使在病情非常严重的情况下也可能取得良好预后。我们报告了两例脑脂肪栓塞后发生阵发性交感神经过度兴奋的病例，这是一种非常罕见的关联情况。
