Abstract
We encountered a patient who developed paroxysmal sympathetic hyperactivity (PSH) after cardiopulmonary resuscitation, which was difficult to treat. The patient was a 33-year-old man who visited us with the chief complaint of general malaise that had persisted for several days. Marked dehydration and nephropathy, rhabdomyolysis, and hyperkalemia were observed, and he experienced cardiopulmonary arrest after arrival at the hospital. While spontaneous circulation was resumed by cardiopulmonary resuscitation, and therapeutic hypothermia was applied, the condition progressed to hypoxic-ischemic encephalopathy. Paroxysmal tachycardia, hypertension, tachypnea, sweating, fever, and myotonia developed in response to stimulation from the 7th hospital day, and the patient was diagnosed as having PSH. The PSH was difficult to treat, and long-term general care was necessary. However, the frequency of paroxysm was decreased by treatment with labetalol, clonazepam, gabapentin, bromocriptine, and dantrolene. Few cases of PSH associated with hypoxic-ischemic encephalopathy have been reported in Japan. The development of PSH should be considered for both head injury and hypoxic encephalopathy.
