case_images: PMC11834331_01
case_images: Clinical images.. A-C: (Axial views) Computed tomography shows hemorrhages in the bilateral frontal lobes, basilar cisterns, and along the falx cerebri. . D-I: (Axial views) Magnetic resonance image performed on the 10th day shows cerebral contusion in bilateral frontal lobes, genu and splenium of the corpus callosum on diffusion-weighted (D-F) and fluid-attenuated inversion recovery images (G-I).
case_images: cureus-0017-00000077653-i01.jpg
case_images: PMC11834331_01_cureus-0017-00000077653-i01.jpg
case_images: FIG1
case_images: A computed tomography scan showed hemorrhages in the bilateral frontal lobes, basilar cisterns, and along the falx cerebri, suggesting elevated intracranial pressure (Figure 1A-1C). Magnetic resonance imaging showed findings of cerebral contusion in bilateral frontal lobes, genu and splenium of the corpus callosum, leading to a diagnosis of diffuse axonal injury (Figure 1D-1I).
case_images: Clinical course.. Schematic diagram showing the type of drugs administered, dosage, duration of administration, and clinical course. The severity of PSH attacks is classified according to the number of attacks per day as follows; grade 0: none: grade 1: 1-2, grade 2: 3-5, grade 3: 6 or more.. CZP: clonazepam, DEX: dexmedetomidine hydrochloride, EEG: electroencephalogram, GCS: Glasgow Coma Scale, GOS: Glasgow Outcome Scale, LCM: lacosamide, MDZ: midazolam, PEG: percutaneous endoscopic gastrostomy, PSH: paroxysmal sympathetic hyperactivity, PTH: phenytoin.
case_images: cureus-0017-00000077653-i02.jpg
case_images: PMC11834331_01_cureus-0017-00000077653-i02.jpg
case_images: FIG2
case_images: The type of drugs administered, the dosage, duration of administration, and clinical course are shown in a schematic diagram (Figure 2). After starting propranolol administration, PSH attacks decreased and disappeared completely, and finally dexmedetomidine hydrochloride could be discontinued (Figure 2).
case_images: Vital signs.. Line graphs showing time courses of the patient's heart rate, body temperature, and respiratory rate during a PSH attack. The thick red horizontal lines indicate the upper normal range for each item. The grid lines on the horizontal axis represent 30-minute intervals.. PSH: paroxysmal sympathetic hyperactivity.
case_images: cureus-0017-00000077653-i03.jpg
case_images: PMC11834331_01_cureus-0017-00000077653-i03.jpg
case_images: FIG3
case_images: At the same time, the body temperature rose to 40.0 C, and the patient also exhibited tachycardia, sweating, and hypertension (Figure 3).
case_images: Electroencephalograms.. Electroencephalograms recorded with referential derivations performed on the 16th and 30th days show no interictal epileptic discharges (left: 16th day, right: 30th day).
case_images: cureus-0017-00000077653-i04.jpg
case_images: PMC11834331_01_cureus-0017-00000077653-i04.jpg
case_images: FIG4
case_images: EEGs were performed twice on the 16th and 30th days, but no epileptic discharges were detected at either time (Figure 4).