Paroxysmal
autonomic instability with dystonia
Complication of severe brain injury. Intermittent
agitation, diaphoresis, hyperthermia, hypertension,
tachycardia, tachypnea, extensor posturing.
Dysfunction of autonomic centers in diencephalon or
their respective connections.
Traumatic and hypoxic brain injury account for most
cases. Other underlying conditions include tumors, intracranial hypertension,
hydrocephalus.
Differential diagnosis: malignant hyperthermia,
NMS, ICH, central fever, infection/sepsis, noncovulsive
epilepsy, agitation, narcotic withdrawal, autonomic
dysreflexia.
Treatment: bromocryptine, clonidine and
propranolol, dantrolene, lorazepam, morphine