{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T05:07:51Z","timestamp":1772168871687,"version":"3.50.1"},"reference-count":10,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2023,10,25]],"date-time":"2023-10-25T00:00:00Z","timestamp":1698192000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns3:p>Paroxysmal autonomic instability with dystonia syndrome (PAIDS) is a rare and life-threatening complication of neurologic diseases. We report the case of a 20-year-old male with acute severe brain damage from tuberculous meningitis, who eventually developed paroxysmal episodes of spontaneous and inducible tachycardia, tachypnea, hypertension, and decerebrate posturing. We diagnosed the patient as suffering from paroxysmal autonomic instability with dystonia syndrome. The unavailability of morphine and the prohibitive cost of prolonged fentanyl use led to a trial of gabapentin, clonazepam, and propranolol for the patient, resulting in symptom resolution. Brain injury causes dysfunction of autonomic centers leading to paroxysmal autonomic instability with dystonia syndrome. Management includes minimizing stimulation and pharmacotherapy with preventive and abortive medications. Alternatives like gabapentin, propranolol and clonazepam were effective in treating the paroxysmal episodes, proving that they may have a role in resource limited settings. PAIDS requires urgent recognition and treatment to prevent further complications and death.<\/ns3:p>","DOI":"10.12688\/f1000research.141196.1","type":"journal-article","created":{"date-parts":[[2023,10,25]],"date-time":"2023-10-25T11:35:08Z","timestamp":1698233708000},"page":"1405","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Case Report: Paroxysmal autonomic instability with dystonia syndrome: a rare complication of tuberculous meningitis"],"prefix":"10.12688","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7813-4146","authenticated-orcid":false,"given":"Lowrence Precious","family":"Dichoso","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerald","family":"Pagaling","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5317-7369","authenticated-orcid":false,"given":"Roland Dominic","family":"G. Jamora","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1241-8805","authenticated-orcid":false,"given":"Veeda Michelle","family":"M. Anlacan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2023,10,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1515-1520","DOI":"10.1089\/neu.2013.3301","article-title":"Paroxysmal sympathetic hyperactivity after acquired brain injury: consensus on conceptual definition, nomenclature and diagnostic criteria.","volume":"31","author":"I Baguley","year":"2014","journal-title":"J. Neurotrauma."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1-5","DOI":"10.1186\/1752-1947-4-304","article-title":"Paroxysmal autonomic instability with dystonia in a patient with tuberculous meningitis: a case report.","volume":"4","author":"N Ramdhani","year":"2010","journal-title":"J. Med. Case Rep."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"201-203","DOI":"10.3233\/JPI-2011-0318","article-title":"Paroxysmal autonomic instability and dystonia (PAID) in a child with tuberculosis meningo-encephalitis: a case report.","volume":"6","author":"S Sarkar","year":"2011","journal-title":"J. Pediatr. Infect. Dis."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"138-153","DOI":"10.1212\/CON.0000000000000811","article-title":"Autonomic hyperactivity.","volume":"26","author":"A Rabinstein","year":"2020","journal-title":"Continuum (Minneap Minn)."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1181-1185","DOI":"10.1080\/02699052.2016.1184757","article-title":"Paroxysmal sympathetic hyperactivity: autonomic instability and muscle over-activity following severe brain injury.","volume":"30","author":"L Letzkus","year":"2016","journal-title":"Brain Inj."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"321-328","DOI":"10.1001\/archneur.61.3.321","article-title":"Paroxysmal autonomic instability with dystonia after brain injury.","volume":"61","author":"J Blackman","year":"2004","journal-title":"Arch. Neurol."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"e22536","DOI":"10.1097\/MD.0000000000022536","article-title":"Transdermal opioid patch in treatment of paroxysmal autonomic instability with dystonia with multiple cerebral insults.","volume":"99","author":"S Baik","year":"2020","journal-title":"Medicine (Baltimore)."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"bcr2014206102","DOI":"10.1136\/bcr-2014-206102","article-title":"Alternating hemidystonia following traumatic brain injury as an unusual presentation of paroxysmal autonomic instability with dystonia syndrome.","volume":"2014","author":"K Buerger","year":"2014","journal-title":"BMJ Case Rep."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e123-e125","DOI":"10.11622\/smedj.2013264","article-title":"Paroxysmal autonomic instability with dystonia (PAID) syndrome following cardiac arrest.","volume":"55","author":"D Kapoor","year":"2014","journal-title":"Singap. Med. J."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"275-278","DOI":"10.1159\/000334276","article-title":"Paroxysmal autonomic instability with dystonia in a child: rare manifestation of an interpeduncular tuberculoma.","volume":"47","author":"D Singh","year":"2012","journal-title":"Pediatr. Neurosurg."}],"container-title":["F1000Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/f1000research.com\/articles\/12-1405\/v1\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/12-1405\/v1\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/12-1405\/v1\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,15]],"date-time":"2024-11-15T04:00:11Z","timestamp":1731643211000},"score":1,"resource":{"primary":{"URL":"https:\/\/f1000research.com\/articles\/12-1405\/v1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,25]]},"references-count":10,"URL":"https:\/\/doi.org\/10.12688\/f1000research.141196.1","relation":{"has-review":[{"id-type":"doi","id":"10.5256\/f1000research.154617.r274512","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.154617.r269320","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.154617.r274520","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.154617.r274512","asserted-by":"object"},{"id-type":"doi","id":"10.5256\/f1000research.154617.r274520","asserted-by":"object"},{"id-type":"doi","id":"10.5256\/f1000research.154617.r269320","asserted-by":"object"}]},"ISSN":["2046-1402"],"issn-type":[{"value":"2046-1402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,25]]},"assertion":[{"value":"Indexed","URL":"https:\/\/f1000research.com\/articles\/12-1405\/v1#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.5256\/f1000research.154617.r269320, Venkat Ramesh, Apollo Hospitals, Hyderabad, Telangana, 09 May 2024, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/12-1405\/v1#referee-response-269320","order":0,"name":"referee-response-269320","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Lowrence Precious Dichoso<\/b>; \n<i>Posted: 14 Nov 2024<\/i>; The diagnosis of CNS tuberculosis was arrived based on the history and supported by the laboratory results. The lumbar tap revealed an elevated opening pressure of 35 and closing pressure of 8. The qualitative&nbsp;cerebrospinal fluid (CSF) is yellowish, clear, with WBC 8x10\n<sup>6<\/sup>\/L (neutrophils 20%, lymphocytes 60%), while the quantitative&nbsp;CSF total protein of 687 mg\/dL, glucose &lt;1.1 mmol\/L (1% of serum glucose). The Crytococcal Antigen Latex Agglutination System, Bactigen Latex Agglutination and fungal culture turned out negative. The CSF MTB- Detection By&nbsp;Polymerase Chain Reaction turned out to be positive.&nbsp;  The Endotracheal Aspiration (ETA) acid-fast bacilli (AFB) was negative but no bronchoscopy was done, however noted on Chest X-ray with reticular opacities of both upper lung field suspicious for tuberculosis.","URL":"https:\/\/f1000research.com\/articles\/12-1405\/v1#referee-comment-12826","order":1,"name":"referee-comment-12826","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.154617.r274512, Shailendra Katwal, Dadeldhura Subregional Hospital,, Dadeldhura,, 04 Jun 2024, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/12-1405\/v1#referee-response-274512","order":2,"name":"referee-response-274512","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.154617.r274520, Nor Osman Sidow, Mogadishu Somalia Turkey Training and Research Hospital, Mogadishu, 05 Sep 2024, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/12-1405\/v1#referee-response-274520","order":3,"name":"referee-response-274520","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":4,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}