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VOLUME 25 , ISSUE 5 ( May, 2021 ) > List of Articles

CASE REPORT

Utility of Serum Procalcitonin in Diagnosing Paroxysmal Sympathetic Hyperactivity in Patients with Traumatic Brain Injury

Ashish Bindra, Vineet Chowdhary, Surya K Dube, Keshav Goyal, Purva Mathur

Keywords : Paroxysmal sympathetic hyperactivity, PCT, Sepsis, Traumatic brain injury (TBI)

Citation Information : Bindra A, Chowdhary V, Dube SK, Goyal K, Mathur P. Utility of Serum Procalcitonin in Diagnosing Paroxysmal Sympathetic Hyperactivity in Patients with Traumatic Brain Injury. Indian J Crit Care Med 2021; 25 (5):580-583.

DOI: 10.5005/jp-journals-10071-23811

License: CC BY-NC 4.0

Published Online: 01-05-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: Paroxysmal sympathetic hyperactivity (PSH) is a grave entity affecting patients following traumatic brain injury (TBI). It presents with cyclic and simultaneous fever, posturing, and other symptoms of sympathetic hyperactivity. Lack of diagnostic tests or biochemical markers and its propensity to mimic other common causes of fever in the neurotrauma intensive care unit (ICU) result in clinical dilemmas and management delay. Case descriptions: We present a case series of four patients (two adults and two pediatrics) with TBI who developed PSH during ICU stay. These patients presented with fever along with variable symptoms of sympathetic hyperactivity. However, the value of serum procalcitonin (PCT) was not elevated, and management of PSH was started. Serial monitoring of PCT helped in differentiating fever due to PSH from sepsis and thus the institution of appropriate and timely treatment of PSH and also helped to use antibiotics rationally. Conclusion: The use of serum PCT in differentiating sepsis from systemic inflammatory reaction and its role in the initiation and titration of antibiotics are well described. PSH is a common entity after TBI, causing episodic fever and sympathetic hyperactivity, often confused with infectious pathology. Our report proposes the role of serum PCT in differentiating PSH from infectious etiology and management of two different clinical entities.


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