Paroxysmal Sympathetic Hyperactivity

CT angiogram of the chestSepsis*White blood cell count
Blood cultures
Serum lactic acidSeizuresElectroencephalogramNeuroleptic malignant syndromeHistory of neuroleptic exposure
Serum creatine kinase
Response to dantroleneSerotonin syndromeHistory of use of proserotonin drugs
Serum creatine kinase
Response to cyproheptadineAlcohol withdrawalHistory of alcohol abuse
Response to benzodiazepinesCushing responseBrain imagingAutonomic dysreflexia from spinal cord injury **Spinal cord imagingEncephalitisCerebrospinal fluidAneurysmal rebleeding in subarachnoid hemorrhageRepeat brain imaging

*Typically associated with hypotension rather than hypertension

**Typically associated with bradycardia rather than tachycardia

Choosing the right medication to treat the spells is not enough, and other aspects of management are equally important. These patients sweat profusely and fluid intake should be adjusted to compensate for this marked increase in insensible losses and to prevent volume contraction. Fever must be aggressively treated with cooling measures as it has a negative impact on the acutely injured brain. It is best to minimize patient stimulation.

TABLE 20.3 Pharmacological Options for the Treatment of Paroxysmal Sympathetic Hyperactivity