title: Paroxysmal sympathetic hyperactivity in brainstem-compressing huge benign tumors: clinical experiences and literature review.
abstract: Severe paroxysmal sympathetic overactivity occurs in a subgroup of patients with acquired brain injuries including traumatic brain injury, hypoxia, infection and tumor-related complications. This condition is characterized by sudden increase of heart rate, respiratory rate, blood pressure, body temperature and excessive diaphoresis. The episodes may be induced by external stimulation or may occur spontaneously. Frequent occurrence of this condition could result in secondary morbidities, therefore, should be diagnosed and managed insightfully. These symptoms could be confused with seizures or other medical conditions, leading to unnecessary treatment. Despite clinical significance of paroxysmal sympathetic hyperactivity (PSH), brain tumor-induced PSH has not been studied nearly. In this report, two cases of the PSH in patients with brainstem-compressing benign tumors were introduced. The most useful pharmacologic agents were opioid (e.g., fentanyl patch) in preventing PSH attack, and nonselective β-blocker (e.g., propranolol) in relieving the symptoms. Clinical experiences of the rare cases of benign tumor-induced PSH can be helpful as an essential basis for further research.
authors.affiliation: Department of Neurological Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 388-1 Pungnab-dong, Songpa-gu, Seoul, 138-736 Republic of Korea.
authors.forename: Seungjoo
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Anesthesia, Bestian Medical Center, Daejeon City, 300-060 Republic of Korea.
authors.forename: Go Woon
authors.initials: GW
authors.lastname: Jun
authors.affiliation: Department of Intensive Care Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, 138-736 Republic of Korea.
authors.forename: Sang Beom
authors.initials: SB
authors.lastname: Jeon
authors.affiliation: Department of Neurological Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 388-1 Pungnab-dong, Songpa-gu, Seoul, 138-736 Republic of Korea.
authors.forename: Chang Jin
authors.initials: CJ
authors.lastname: Kim
authors.affiliation: Department of Neurological Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 388-1 Pungnab-dong, Songpa-gu, Seoul, 138-736 Republic of Korea.
authors.forename: Jeong Hoon
authors.initials: JH
authors.lastname: Kim
keywords: Brain tumor; Brainstem; Opioid; Paroxysmal sympathetic hyperactivity