Title : A case of paroxysmal sympathetic hyperactivity induced by renal stones in a chronically ventilated child
Abstract:
Introduction: Paroxysmal sympathetic hyperactivity (PSH) which was previously called sympathetic storming, is a clinical disorder mainly caused by traumatic brain injury, stroke, hypoxic brain injury or encephalitis. The clinical features include sudden episodes of hypertension, tachycardia, tachypnoea, fever. sweating and dystonic postures. Even though majority of the episodes are spontaneous, few of the episodes may be triggered by pain or infection. We report a case of sympathetic storming in a child with HIE, found to be triggered by renal stones. Removal of the stones led to the control of symptoms.
Case report: One year boy, a known case of Hypoxic Ischemic Encephalopathy, chronically ventilated child , noted to have frequent episodes of sympathetic storming, difficult to control, most of the episodes required multiple medications including benzodiazepines and propranolol. Markers of infection and cultures were negative. In search for a trigger, noted to have ureteric stones in ultrasonography. Presence of stones were confirmed by CT scan of abdomen. He underwent cystoscopic removal of stones , which lead to the resolution of symptoms.
Conclusion: Since the pathology of sympathetic storming is still not clear, symptom control is the primary aim of treatment. Search for a trigger is also mandated as in our case. Treatment of underlying cause can lead to resolution of symptoms.
