2018, Number 6
Rev Mex Neuroci 2018; 19 (6)
Paroxysmal sympathetic hyperactivity: prevalence, treatment and neuroradiological findings in pediatric patients
Bravo-Oro A, Hernández-Rodríguez HG, Reyes-Vaca JG, Villegas-Aguilera M, Gómez-Elías CL, Rivera-Vega R, Mendoza-Moreno LF, García-Ramírez JL
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ABSTRACTObjective: Paroxysmal sympathetic hyperactivity is a disorder poor studied and understood in pediatrics. It is mainly associated with cranioencephalic trauma and hypoxia. Is characterized by self-limited and recurrent episodes of hypertension, tachycardia, tachypnea, hyperthermia, sialorrhea, mydriasis, hyperhidrosis, decreased level of consciousness and increased muscle tone with extension posture. In pediatric age, a prevalence of 12-29% is estimated. Methods: A retrospective study was conducted with patients admitted in the period from January 2002 to January 2017 in pediatric intensive care. Seven cases met the diagnostic criteria of paroxysmal sympathetic hyperactivity. Results: The mean age was 1-14 years, the most frequent etiology was associated with cardiorespiratory arrest. They started with the disorder in an average of 21.74 days (standard deviation [SD] 18.37), the treatment started on average of 2.00 days (SD 2.07) and internment time in a range of 20-180 days, therapy stay with a range of 10-40 days. The drugs used to control the condition were propranolol, baclofen, buprenorphine and gabapentin, achieving control on average of 5.14 days (SD 2.17). The most frequent findings in magnetic resonance were hypoxic ischemic lesions in white matter, basal ganglia and thalami. Conclusions: Paroxysmal sympathetic hyperactivity is a serious condition associated with high morbidity and mortality. The prevalence in our series was 1.12%, very low compared to that reported by other authors. A consensus must be established to establish diagnostic criteria and treatment in the pediatric population.