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Case Rep Neurol Med. 2015;2015:421563. doi: 10.1155/2015/421563. Epub 2015 Jun 18.

Propranolol for Paroxysmal Sympathetic Hyperactivity with Lateralizing Hyperhidrosis after Stroke.

Author information

1
Department of Neurology, VA New York Harbor Healthcare System, 423 East 23rd Street No. 127, New York, NY 10010, USA.
2
Department of Neurology, Mount Sinai Beth Israel Medical Center, New York, NY 10003, USA.

Abstract

Brain injury can lead to impaired cortical inhibition of the hypothalamus, resulting in increased sympathetic nervous system activation. Symptoms of paroxysmal sympathetic hyperactivity may include hyperthermia, tachycardia, tachypnea, vasodilation, and hyperhidrosis. We report the case of a 41-year-old man who suffered from a left middle cerebral artery stroke and subsequently developed central fever, contralateral temperature change, and hyperhidrosis. His symptoms abated with low-dose propranolol and then returned upon discontinuation. Restarting propranolol again stopped his symptoms. This represents the first report of propranolol being used for unilateral dysautonomia after stroke. Propranolol is a lipophilic nonselective beta-blocker which easily crosses the blood-brain barrier and may be used to treat paroxysmal sympathetic hyperactivity.

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