Question

Diagnosis of Paroxysmal Sympathetic Hyperactivity.

Hint:

Diagnosis of PSH involves identifying characteristic episodes of sympathetic overactivity, with neuroimaging and blood tests used to identify underlying causes.

Answer 1

The diagnosis of paroxysmal sympathetic hyperactivity (PSH) is primarily clinical, based on the recognition of characteristic signs and symptoms. Additional tests may be used to rule out other causes of sympathetic hyperactivity and to identify the underlying cause.
Step 1: Clinical Presentation:
1. Symptomatic Episodes: The patient exhibits sudden and recurrent episodes of sympathetic activation, such as increased heart rate (tachycardia), high blood pressure (hypertension), excessive sweating, fever, and restlessness. These episodes are typically transient and resolve once the triggering factor is addressed.
2. History and Physical Examination: A thorough medical history and physical examination are essential to identify potential triggers, such as recent neurological injury, infection, or trauma.
Step 2: Diagnostic Tests:
1. Blood Pressure Monitoring: Continuous or intermittent blood pressure monitoring may be used to assess the severity and frequency of hypertension episodes during paroxysms.
2. Heart Rate Monitoring: The patient may have episodes of tachycardia that correlate with the paroxysmal events.
3. Neuroimaging: MRI or CT scans of the brain may be performed to identify any neurological lesions, such as stroke or brain injury, that may be causing the sympathetic hyperactivity.
4. Blood Tests: Blood tests may be used to rule out infections or metabolic imbalances as contributing factors.