O'Keefe Lena M, Mui Gracia
Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA.
Department of Neurology, University of Connecticut Health Center, Farmington, CT.
Neurologist. 2020 Mar;25(2):24-25. doi: 10.1097/NRL.0000000000000258.
Paroxysmal sympathetic hypersensitivity (PSH) has become more frequently recognized in patients with severe neurological brain injury. Left untreated, PSH has been associated with poor neurological outcomes. Currently, most therapeutic options are circumstantial with evidence stemming from subjective case reports.
Two young females were admitted after cardiac arrest and found to have anoxic brain injury with subsequent PSH. Initial treatment was targeted at relief of the hyperadrenergic symptoms, which included bromocriptine, propranolol, opioids and benzodiazepines. These therapies were minimally effective, and the patients remained comatose. After initiation of enteral baclofen treatment, they exhibited drastic reduction of PSH symptoms and became alert and interactive. After a 6-week hospital stay, they were both discharged to long-term rehabilitation centers.
This case series reviews the current therapies used for PSH and discusses 2 patients with uncontrolled PSH secondary to anoxic brain injury. Both patients arose from coma and had significant symptomatic improvement with enteral baclofen treatment. Thus, enteral baclofen should be considered as a primary treatment for PSH to prevent sustained symptoms and prolonged hospitalizations.
阵发性交感神经过度兴奋（PSH）在重度神经性脑损伤患者中越来越常见。若不治疗，PSH与不良神经学预后相关。目前，大多数治疗选择都是基于主观病例报告的证据，具有偶然性。
两名年轻女性在心脏骤停后入院，被发现患有缺氧性脑损伤并继发PSH。初始治疗旨在缓解高肾上腺素能症状，包括使用溴隐亭、普萘洛尔、阿片类药物和苯二氮䓬类药物。这些治疗效果甚微，患者仍处于昏迷状态。开始肠内巴氯芬治疗后，她们的PSH症状大幅减轻，变得清醒且有互动。经过6周的住院治疗后，她们均出院前往长期康复中心。
本病例系列回顾了目前用于治疗PSH的疗法，并讨论了2例因缺氧性脑损伤继发PSH且病情未得到控制的患者。两名患者均从昏迷中苏醒，肠内巴氯芬治疗后症状有显著改善。因此，肠内巴氯芬应被视为PSH的主要治疗方法，以预防症状持续和住院时间延长。
