title: Diencephalic storms from leptomeningeal metastases and leukoencephalopathy: a rare and clinically important complication.
abstract: Diencephalic storms or paroxysmal sympathetic storms are characterized by episodic hyperhidrosis, hypertension, tachypnea, tachycardia, and abnormal posturing. These have been reported to occur in patients with hydrocephalus, intracranial tumors, and hypoxic, ischemic, or traumatic brain injury. They can be easily misdiagnosed as seizures, uncontrolled pheochromocytoma, drug withdrawal, thyroid storm, hypertensive crises, and sepsis or anxiety attacks. The most effective treatment to control these symptoms is yet to be identified. We present 2 individuals exhibiting these sympathetic surges; one whose symptoms were controlled with phenobarbital and the other with clonidine and oxycodone. Palliative medicine physicians should be made aware of this unusual complication.
authors.affiliation: 1Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, Cleveland, OH, USA.
authors.forename: Aileen
authors.initials: A
authors.lastname: Soriano
authors.forename: Terence L
authors.initials: TL
authors.lastname: Gutgsell
authors.forename: Mellar P
authors.initials: MP
authors.lastname: Davis
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D005260:Female; D006801:Humans; D056784:Leukoencephalopathies / Q000150:complications*; D008297:Male; D008577:Meningeal Neoplasms / Q000150:complications*; D012640:Seizures / Q000188:drug therapy / Q000209:etiology*
chemical_list: D000927:Anticonvulsants
keywords: diencephalic; epilepsy; leptomeningeal; sympathetic