Question

Management of Paroxysmal Sympathetic Hyperactivity.

Hint:

Acute management of PSH involves controlling sympathetic activation with sedatives and beta-blockers, while addressing the underlying cause is key to long-term management.

Answer 1

Management of paroxysmal sympathetic hyperactivity (PSH) focuses on controlling the acute sympathetic episodes, addressing the underlying cause, and preventing future episodes.
Step 1: Acute Management:
1. Sedation: Benzodiazepines, such as lorazepam or diazepam, are often used to sedate the patient and reduce the sympathetic overactivity during an episode.
2. Beta-blockers: Beta-blockers like propranolol can be used to control tachycardia and hypertension, common symptoms during the paroxysms.
3. Alpha-blockers: Alpha-adrenergic blockers, such as clonidine, may be used to reduce blood pressure and control sympathetic activation.
Step 2: Long-term Management:
1. Address Underlying Causes: The management of any underlying conditions, such as neurological injury, infection, or metabolic imbalances, is crucial for long-term control of PSH.
2. Sympathetic Nerve Block: In some cases, a sympathetic nerve block may be considered as a longer-term intervention to control the excessive sympathetic activity.
Step 3: Prevention of Future Episodes:
1. Pain Management: Effective control of pain, which can trigger PSH episodes, is essential in preventing recurrent episodes.
2. Management of Stress: Psychological support and stress management techniques, such as relaxation therapy or counseling, can help in reducing triggers of PSH.