Case Report: Probable paroxysmal sympathetic hyperactivity during vascular and postoperative critical illness with bilateral white matter abnormalities
Abstract
BackgroundRecognition of paroxysmal sympathetic hyperactivity (PSH) during vascular and postoperative critical illness is complicated by overlapping infection and seizure features.Case presentationA 37-year-old man developed encephalopathy and rigidity after extensive arterial thrombosis, thrombectomy, and suspected postoperative sepsis. January 2025 observations documented recurrent, transient, simultaneous tachycardia, increased blood pressure, tachypnea, fever, sweating, and abnormal posturing. The treating team diagnosed PSH, which remained among the February 12 transfer diagnoses. Brain magnetic resonance images dated February 20, 2025, showed symmetric bilateral periventricular and deep white matter abnormalities without definite diffusion restriction. Targeted serum and cerebrospinal fluid antibody testing was negative. A clinician-completed PSH Assessment Measure (PSH-AM) recorded 24 points; conservative reassessment retained recorded severity grades and yielded 20, still classified as probable PSH. Paroxysms persisted as documented infection improved, decreased during multimodal treatment, and recurred during combined medication reduction. At the February 12 intrahospital rehabilitation transfer, communication and tone had improved, but contractures and severe limb motor impairment persisted. Cerebral etiology remained uncertain, and seizures could not be excluded because electroencephalographic event capture was unavailable.ConclusionThe case highlights serial clinical recognition of probable PSH during vascular and postoperative critical illness, alongside infection assessment and attention to persistent rehabilitation needs.
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BibTeX
@article{li2026case,
title = {{Case Report: Probable paroxysmal sympathetic hyperactivity during vascular and postoperative critical illness with bilateral white matter abnormalities}},
author = {Mozhen Li and Yujie Wei and Zhenhua Cai and Lusheng Wang and Shengwen Guo and Jifei Cao and Heng Tang and Lei Wang},
journal = {Frontiers in Neuroscience},
year = {2026},
month = oct,
doi = {10.3389/fnins.2026.1935805},
url = {https://www.frontiersin.org/articles/10.3389/fnins.2026.1935805},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Case Report: Probable paroxysmal sympathetic hyperactivity during vascular and postoperative critical illness with bilateral white matter abnormalities
AU - Mozhen Li
AU - Yujie Wei
AU - Zhenhua Cai
AU - Lusheng Wang
AU - Shengwen Guo
AU - Jifei Cao
AU - Heng Tang
AU - Lei Wang
PY - 2026
DA - 2026/10/29
JO - Frontiers in Neuroscience
DO - 10.3389/fnins.2026.1935805
UR - https://www.frontiersin.org/articles/10.3389/fnins.2026.1935805
AB - BackgroundRecognition of paroxysmal sympathetic hyperactivity (PSH) during vascular and postoperative critical illness is complicated by overlapping infection and seizure features.Case presentationA 37-year-old man developed encephalopathy and rigidity after extensive arterial thrombosis, thrombectomy, and suspected postoperative sepsis. January 2025 observations documented recurrent, transient, simultaneous tachycardia, increased blood pressure, tachypnea, fever, sweating, and abnormal posturing. The treating team diagnosed PSH, which remained among the February 12 transfer diagnoses. Brain magnetic resonance images dated February 20, 2025, showed symmetric bilateral periventricular and deep white matter abnormalities without definite diffusion restriction. Targeted serum and cerebrospinal fluid antibody testing was negative. A clinician-completed PSH Assessment Measure (PSH-AM) recorded 24 points; conservative reassessment retained recorded severity grades and yielded 20, still classified as probable PSH. Paroxysms persisted as documented infection improved, decreased during multimodal treatment, and recurred during combined medication reduction. At the February 12 intrahospital rehabilitation transfer, communication and tone had improved, but contractures and severe limb motor impairment persisted. Cerebral etiology remained uncertain, and seizures could not be excluded because electroencephalographic event capture was unavailable.ConclusionThe case highlights serial clinical recognition of probable PSH during vascular and postoperative critical illness, alongside infection assessment and attention to persistent rehabilitation needs.
SN - 1662-453X
ER -