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目的探讨阵发性交感神经过度兴奋(paroxysmal sympathetic hyperactivity,PSH)的临床特征、诊断和治疗。方法对2例PSH患者的病程、临床表现及辅助检查及诊疗过程进行分析。结果 2例患者中1例是脑干出血患者,另1例是大面积脑梗死患者。2例患者均以阵发性躁动、高热、大汗、血压升高、心动过速、呼吸急促及肌张力障碍等为主要临床表现。发作间期格拉斯哥昏迷评分分别为5和15分。2例患者均行脑电图检查,均未见癫痫波。神经影像学检查提示额叶、颞叶、顶叶、脑干等部位损伤。23例抗癫痫药物治疗无效;β受体阻滞剂和加巴喷丁联合应用对PSH有较好疗效。结论不同病因、不同程度脑干出血与脑梗死均可导致PSH。PSH易被误诊为癫痫,抗癫痫治疗无效。β受体阻滞剂和加巴喷丁联合治疗有效。
Objective To investigate the clinical features, diagnosis and treatment of paroxysmal sympathetic hyperactivity (PSH). Methods The course of disease, clinical manifestations, secondary examination and diagnosis and treatment of 2 patients with PSH were analyzed. Results One of the two patients was bleeding from the brainstem and the other one was from a large area of cerebral infarction. Both of the two patients presented with paroxysmal agitation, fever, sweating, elevated blood pressure, tachycardia, shortness of breath and dystonia as the main clinical manifestations. Glasgow coma score interval were 5 and 15 points. 2 patients underwent EEG examination, no waves of epilepsy. Nerve imaging examination showed that the frontal lobe, temporal lobe, parietal lobe, brain stem and other parts of the injury. 23 cases of antiepileptic drugs ineffective; β-blockers and gabapentin combined application of PSH has a good effect. Conclusion Different causes, different degrees of brainstem hemorrhage and cerebral infarction can lead to PSH. PSH easily misdiagnosed as epilepsy, anti-epilepsy treatment ineffective. β-blockers and gabapentin combination therapy is effective.