Article Data

  • Views 1471
  • Dowloads 127

Case Report

Open Access

Sympathetic hyperactivity syndrome following cerebral fat embolization


1,Department of Anesthesiology Divison of Critical Care Mayo Clinic

2Department of Neurology Division of Critical Care, Mayo Clinic

DOI: 10.22514/SV91.042014.10 Vol.9,Issue 1,April 2014 pp.53-56

Published: 30 April 2014

*Corresponding Author(s): JEFFREY B JENSEN E-mail:


To date, there have been no reports of paroxysmal sympathetic hyperactivity syndrome (PSHS) associated with cerebral fat embolization. We describe the case of a young male who developed acute brain injury and acute hypoxemic respiratory failure secondary to significant fat embolization following a traumatic femur injury. Our patient demonstrated episodes of significant hypertension, tachycardia, fever and extensor posturing. Extensive evaluation lead to the diagnosis and appropri-ate treatment for PSHS. Ultimately, the patient went on to have a good neurologic recovery after a prolonged hospitalization. We will discuss PSHS diagnostic criteria, pathophysiology and treatment options. This diagnosis should be considered in all brain-injured patients with paroxysms of autonomic instability and abnormal movements.


acute brain injury, myoc-lonic encephalopathy, fat emboli-sm, autonomic nervous system diseases, adult respiratory distress syndrome,wound, injuries

Cite and Share

JEFFREY B JENSEN,JAMES ONIGKEIT,SARA HOCKER. Sympathetic hyperactivity syndrome following cerebral fat embolization. Signa Vitae. 2014. 9(1);53-56.


1. Takahashi M, Suzuki R, Osakabe Y, Asai J, Miyo T, Nagashima G, et al. Magnetic resonance imaging findings in cerebral fat embolism: correlation with clinical manifestations. J Trauma 1999;46(2):324-7.

2. Penfield W. Diencephalic Autonomic Epilepsy. Arch Neurol Psychiatry 1929;22:2.

3. Perkes I, Baguley IJ, Nott MT, Menon DK. A review of paroxysmal sympathetic hyperactivity after acquired brain injury. Ann Neurol 2010;68(2):126-35.

4. Rabinstein AA. Paroxysmal sympathetic hyperactivity in the neurological intensive care unit. Neurol Res 2007;29(7):680-2.

5. Blackman JA, Patrick PD, Buck ML, Rust RS. Paroxysmal autonomic instability with dystonia after brain injury. Arch Neurol 2004;61(3):321-8.

6. Diesing TS, Wijdicks EF. Arc de cercle and dysautonomia from anoxic injury. Mov Disord 2006;21(6):868-9.

7. Solomon GE. Diencephalic autonomic epilepsy caused by a neoplasm. J Pediatr 1973;83(2):277-80.

8. Goh KY, Conway EJ, DaRosso RC, Muszynski CA, Epstein FJ. Sympathetic storms in a child with a midbrain glioma: a variant of dience-phalic seizures. Pediatr Neurol 1999;21(4):742-4.

9. McLean A. Autonomic epilepsy: report of a case with observation at necropsy. Arch Neurol Psychiatry 1934;1934(32):189-97.

10. Boeve BF, Wijdicks EF, Benarroch EE, Schmidt KD. Paroxysmal sympathetic storms ("diencephalic seizures") after severe diffuse axonal head injury. Mayo Clin Proc 1998;73(2):148-52.

11. Wang VY, Manley G. Recognition of paroxysmal autonomic instability with dystonia (PAID) in a patient with traumatic brain injury. J Trauma 2008;64(2):500-2.

12. Bullard DE. Diencephalic seizures: responsiveness to bromocriptine and morphine. Ann Neurol 1987;21(6):609-11.

13. Baguley IJ. The excitatory:inhibitory ratio model (EIR model): An integrative explanation of acute autonomic overactivity syndromes. Med Hypotheses 2008;70(1):26-35.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time