[Autonomic dysfunction in children with traumatic brain injury].
BACKGROUND
Autonomic dysfunction syndrome following traumatic brain injury is a situation involving adrenergic hyperactivity produced by the lack of control over the autonomous nervous system at a central level. The difficulties involved in its therapeutic management make it even more important.


METHODS
We report the cases of a boy and a girl aged 6 and 12 years, respectively, who had suffered a severe traumatic brain injury with important brain damage that included diencephalic and mesencephalic compromise and areas of diffuse axonal injury. From the acute phase onwards, they presented episodes of hypertension, tachycardia, excessive sweating and spasticity in the form of attacks that initially led to a differential diagnosis between sepsis, opiate and/or benzodiazepine withdrawal syndrome and epilepsy. The length of time spent in coma was very long and the attacks went on throughout the awakening phase almost until the moment they were discharged from hospital, despite trying different treatments. In our cases, orally administered baclofen and midazolam seemed to be the most effective.


CONCLUSIONS
Autonomic dysfunction is difficult to manage. There are no standardised treatments and speculation continues with regard to its true promoter. We might think that the central injury is the cause of the process and that the autonomic dysfunction increases the secondary lesion and contributes to the functional worsening. If we take into account that the survival rate of the children is high despite the severity of the injuries and although the dysautonomia can be self-limiting with time, we believe that its treatment is essential if the ultimate aim is to minimise the sequelae.
Rodríguez
N
N
Servicio de Rehabilitación y Medicina Física, Hospital Universatari Sant Joan de Déu, 08950 Esplugues de Llobregat, Barcelona, Spain. nrodriguez@hsjdbcn.org
Febrer
A
A
Meléndez
M
M
D001342:Autonomic Nervous System Diseases / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D001418:Baclofen / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology; D001831:Body Temperature / Q000502:physiology; D001930:Brain Injuries / Q000150:complications* / Q000473:pathology; D002648:Child; D003128:Coma; D005260:Female; D018755:GABA Agonists / Q000627:therapeutic use; D018757:GABA Modulators / Q000627:therapeutic use; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008874:Midazolam / Q000627:therapeutic use
D018755:GABA Agonists; D018757:GABA Modulators; D001418:Baclofen; D008874:Midazolam