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Sepsis or sympathetics? Paroxysmal sympathetic hyperactivity after pontine stroke
  1. Pratibha Surathi1,
  2. Jessica Sher2,
  3. Nadeem Obaydou2 and
  4. Kathleen Mangunay Pergament2
  1. 1Neurology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
  2. 2Internal Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
  1. Correspondence to Dr Pratibha Surathi; pratibha.surathi{at}


A 64-year-old man from nursing home with a pontine stroke 3 months ago, ventilator-dependent, presented with episodic fever, tachycardia and tachypnoea occurring several times a day. He was evaluated for sepsis and pulmonary embolism and was treated empirically with broad-spectrum antibiotics. But these episodes persisted. Due to the episodic nature and typical symptoms of sympathetic overactivity, in the setting of prior brain injury, paroxysmal sympathetic hyperactivity was considered. His antibiotics were discontinued, and he was treated symptomatically with baclofen and bromocriptine, which resulted in a partial reduction of these episodes.

  • stroke
  • long term care

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  • Contributors PS: Conceptualisation, literature search, manuscript writing and revision. JS: Literature search, revision of the manuscript and obtaining consent. NO: Literature search and revision of the manuscript. KMP: Conceptualisation and revision of manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer-reviewed.