Paroxysmal sympathetic hyperactivity syndrome caused by fat embolism syndrome

Daniel Agustin Godoy, Jose Orquera, Alejandro A. Rabinstein

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Paroxysmal sympathetic hyperactivity represents an uncommon and potentially life-threatening complication of severe brain injuries, which are most commonly traumatic. This syndrome is a clinical diagnosis based on the recurrent occurrence of tachycardia, hypertension, diaphoresis, tachypnea, and occasionally high fever and dystonic postures. The episodes may be induced by stimulation or may occur spontaneously. Underdiagnosis is common, and delayed recognition may increase morbidity and long-term disability. Trigger avoidance and pharmacological therapy can be very successful in controlling this complication. Fat embolism syndrome is a rare but serious complication of long bone fractures. Neurologic signs, petechial hemorrhages and acute respiratory failure constitute the characteristic presenting triad. The term cerebral fat embolism is used when the neurological involvement predominates. The diagnosis is clinical, but specific neuroimaging findings can be supportive. The neurologic manifestations include different degrees of alteration of consciousness, focal deficits or seizures. Management is supportive, but good outcomes are possible even in cases with very severe presentation. We report two cases of paroxysmal sympathetic hyperactivity after cerebral fat embolism, which is a very uncommon association.

Original languageEnglish (US)
Pages (from-to)237-243
Number of pages7
JournalRevista Brasileira de Terapia Intensiva
Issue number2
StatePublished - Apr 1 2018


  • Autonomic nervous system diseases
  • Brain injuries
  • Embolism
  • Fat
  • Primary dysautonomia

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine


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