TY - JOUR T1 - Treatment of paroxysmal sympathetic storm with labetalol JF - Journal of Neurology, Neurosurgery & Psychiatry JO - J Neurol Neurosurg Psychiatry SP - 832 LP - 833 DO - 10.1136/jnnp.69.6.832 VL - 69 IS - 6 AU - D DO AU - V L SHEEN AU - E BROMFIELD Y1 - 2000/12/01 UR - http://jnnp.bmj.com/content/69/6/832.abstract N2 - First described by Penfield in 1929, paroxysmal sympathetic storm is characterised by episodic hyperhidrosis, hypertension, hyperthermia, tachypnoea, tachycardia, and posturing. It has commonly been associated with closed head traumatic brain injury, agenesis of the corpus callosum, hydrocephalus, and suprasellar or diencephalic tumours.1 2 Penfield hypothesised that these sympathetic spells were caused by epileptiform discharges in thalamic nuclei irritated by increased intracranial pressure, thereby leading him to name this entity “diencephalic autonomic seizures”.2Electroencephalograms obtained on patients during these autonomic attacks, however, have not shown epileptic activity, and anticonvulsant therapies have not proved useful in their treatment.2 3Bromocriptine and morphine have been the standard treatments for paroxysmal sympathetic storm, and propranolol has been shown to reduce the hyperpyrexia seen during autonomic spells.3 4 In this case report, we describe a patient treated successfully with labetalol, but not metoprolol, suggesting that β1 antagonism alone is not sufficient to suppress paroxysmal sympathetic storm.A 21 year old white man was an unrestrained passenger in a motor vehicle accident and developed a closed head shear injury. He was admitted to a hospital where a head CT showed hydrocephalus necessitating a ventriculoperitoneal shunt placement. A head MRI showed abnormal T2 signal in the corpus callosum and the dorsal midbrain consistent with shear injury. Although initially comatose, he improved to near baseline over the next few months. He was admitted to our hospital 15 months later with a shunt infection, necessitating treatment with vancomycin, shunt externalisation, and, eventually, replacement. During and after resolution of … ER -