Clinical features of paroxysmal sympathetic hyperactivity in brain tumor: a retrospective case series study and literature review.

BACKGROUND

Paroxysmal sympathetic hyperactivity (PSH) is a rare complication of brain tumor, mostly occurred after craniotomy for brain tumor resection. The purpose of this study is to characterize the pathogenesis and clinical features of PSH in brain tumor.

METHODS

All PSH cases with brain tumor at a single center over a 4-year period were retrospectively identified based on medical records. A systematic literature review of the PSH cases with brain tumor was also conducted. PubMed and Web of Science databases were searched.

RESULTS

We identified nine patients at our center and 14 patients in the literature with brain tumor and PSH. There were 10 adult patients and 13 pediatric patients with a median age of 13 years. Most tumors (96 %) were located in deep brain regions. The brainstem and adjacent structures were the most common tumor locations, accounting for 70 %. Glioma (39 %) was the most common pathology type. The onset of PSH occurred after tumor resection or biopsy in 18 patients, during tumor resection in two patients, and during conservative treatment in three patients. The most common PSH symptoms in brain tumor were hypertension (100 %) and tachycardia (96 %).

CONCLUSIONS

PSH is not only an underlying complication of brain tumor resection, but also a rare clinical manifestation of brain tumor. We speculate that damage to the midbrain or pons, especially close to the midline of the tegmentum, might be one of the lesion patterns underlying PSH.