阵发性交感神经过度兴奋2例报道及相关文献复习

目的 探讨阵发性交感神经过度兴奋(paroxysmal sympathetic hyperactivity,PSH)的临床特征、诊断和治疗。方法 对2例PSH患者的病程、临床表现及辅助检查及诊疗过程进行分析。结果 2例患者中1例是脑干出血患者,另1例是大面积脑梗死患者。2例患者均以阵发性躁动、高热、大汗、血压升高、心动过速、呼吸急促及肌张力障碍等为主要临床表现。发作间期格拉斯哥昏迷评分分别为5和15分。2例患者均行脑电图检查,均未见癫痫波。神经影像学检查提示额叶、颞叶、顶叶、脑干等部位损伤。23例抗癫痫药物治疗无效; β受体阻滞剂和加巴喷丁联合应用对PSH有较好疗效。结论 不同病因、不同程度脑干出血与脑梗死均可导致PSH。PSH易被误诊为癫痫,抗癫痫治疗无效。β受体阻滞剂和加巴喷丁联合治疗有效。

Two patients with paroxysmal sympathetic hyperactivity: clinical experiences and literature review

ObjectiveTo investigate the clinical characteristics, diagnose and treatment of paroxysmal sympathetic hyperactivity.Methods The clinical manifestations, auxiliary examinations, diagnosis and treatment process of 2 patients with PSH were analyzed in this research.Results There were a brainstem hemorrhage patient and a large area cerebral infarction patient. Both of them had suffered from paroxysmal agitation, high fever, sweating, blood pressure, tachycardia, and shortness of breath and dystonia symptoms. During the attack period the Glasgow Coma Scale scores of 2 patients were 5 and 15 points respectively. No epilepsy waves were discovered in EEG examination. Neural imaging examination had demonstrated that frontal lobe, temporal lobe, parietal lobe and brain stem were damaged. Anti-epileptic drug treatment of 23 cases was invalid, while the combined application of β-blockers and gabapentin had a good curative effect.Conclusion Both brainstem hemorrhage and cerebral infarction could lead to PSH. PSH could be misdiagnosed as epilepsy and anti-epileptic treatment was invalid. The combination therapy of β-blockers and garmentin was effective.