{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T10:07:03Z","timestamp":1770372423921,"version":"3.49.0"},"reference-count":88,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"22","license":[{"start":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T00:00:00Z","timestamp":1748822400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2025,6,2]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>The management of asymptomatic untreated chronic hydrocephalus in adults remains controversial. Acute deterioration is uncommon. However, decompensation of stable patients has been described following trauma, physical activity, medical procedures, or Valsalva maneuvers. The authors report a case of acute decompensation after elective abdominal surgery in an adult with chronic hydrocephalus with an unusual clinical presentation of paroxysmal sympathetic hyperactivity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>The decompensation manifested as episodes of paroxysmal sympathetic hyperactivity associated with features of dorsal midbrain impairment. The patient presented with transient episodes of decreased level of consciousness, tachycardia, hypertension, flushing, and sweating. He had upgaze restriction, lack of convergence, and pupillary dilatation, and his pupils were unresponsive to light. There was no structural change on brain imaging. The sympathetic hyperactivity and oculomotor abnormalities resolved with CSF diversion, and the patient made a complete neurological recovery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Patients with chronic untreated hydrocephalus can decompensate due to increased physiological stress. Adult patients with untreated chronic hydrocephalus should be counseled about this possibility and evaluated carefully by a multidisciplinary team before consenting to major elective surgery. The presentation of acute decompensation can include paroxysmal sympathetic hyperactivity, which should be diagnosed and treated urgently, even if there is no radiological evidence of ventricular change.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE2547\">https:\/\/thejns.org\/doi\/10.3171\/CASE2547<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case2547","type":"journal-article","created":{"date-parts":[[2025,6,9]],"date-time":"2025-06-09T19:46:15Z","timestamp":1749498375000},"source":"Crossref","is-referenced-by-count":0,"title":["Acute decompensation of chronic hydrocephalus following elective abdominal surgery presenting as paroxysmal sympathetic hyperactivity: illustrative case"],"prefix":"10.3171","volume":"9","author":[{"given":"Catherine","family":"Veilleux","sequence":"first","affiliation":[{"name":"Department of Clinical Neurosciences, Division of Neurosurgery, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan T.","family":"Lang","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Neurosurgery, University of British Columbia, Calgary, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Regan","family":"King","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark G.","family":"Hamilton","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences, Division of Neurosurgery, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"6","key":"bib1","series-title":"J Neurosurg","first-page":"1773","article-title":"The clinical spectrum of hydrocephalus in adults: report of the first 517 patients of the Adult Hydrocephalus Clinical Research Network registry","volume":"132","author":"Williams","year":"2020","unstructured":"Williams MANagel SJLuciano MGThe clinical spectrum of hydrocephalus in adults: report of the first 517 patients of the Adult Hydrocephalus Clinical Research Network registry. J Neurosurg. 2020;132(6):1773-1784."},{"issue":"3","key":"bib2","series-title":"J Neurosurg","first-page":"887","article-title":"Cognitive and gait outcomes after primary endoscopic third ventriculostomy in adults with chronic obstructive hydrocephalus","volume":"136","author":"Zwimpfer","year":"2022","unstructured":"Zwimpfer TJSalterio NWilliams MACognitive and gait outcomes after primary endoscopic third ventriculostomy in adults with chronic obstructive hydrocephalus. J Neurosurg. 2022;136(3):887-894."},{"key":"bib3","series-title":"World Neurosurg","first-page":"647","article-title":"Nowhere to go: the challenge of health care transition for youth with hydrocephalus","volume":"134","author":"Williams","year":"2020","unstructured":"Williams MAvan der Willigen TGray DDHamilton MG.Nowhere to go: the challenge of health care transition for youth with hydrocephalus. World Neurosurg. 2020;134:647-649."},{"key":"bib4","series-title":"Dev Med Child Neurol","first-page":"4","article-title":"Spontaneously arrested hydrocephalus. Results of the re-examination of 82 survivors from a series of 182 unoperated cases","author":"Laurence","year":"1967","unstructured":"Laurence KMCoates S.Spontaneously arrested hydrocephalus. Results of the re-examination of 82 survivors from a series of 182 unoperated cases. Dev Med Child Neurol. 1967:4-13."},{"issue":"2","key":"bib5","series-title":"Pediatr Neurosurg","first-page":"101","article-title":"An approach to the management of arrested and compensated hydrocephalus","volume":"19","author":"McLone","year":"1993","unstructured":"McLone DGAronyk KE.An approach to the management of arrested and compensated hydrocephalus. Pediatr Neurosurg. 1993;19(2):101-103."},{"issue":"2","key":"bib6","series-title":"Acta Neurol Scand","first-page":"81","article-title":"Adult patients with \u201casymptomatic\u201d and \u201ccompensated\u201d hydrocephalus benefit from surgery","volume":"99","author":"Larsson","year":"1999","unstructured":"Larsson AStephensen HWikkels\u00f8 C.Adult patients with \u201casymptomatic\u201d and \u201ccompensated\u201d hydrocephalus benefit from surgery. Acta Neurol Scand. 1999;99(2):81-90."},{"key":"bib7","series-title":"Clin Neurol Neurosurg","first-page":"79","article-title":"Surgical management of arrested hydrocephalus: case report, literature review, and 18-month follow-up","volume":"151","author":"Hong","year":"2016","unstructured":"Hong JBarrena BGLollis SSBauer DF.Surgical management of arrested hydrocephalus: case report, literature review, and 18-month follow-up. 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Arch Neurol Psychiatry. 1929;22(2):358-374."},{"issue":"4","key":"bib14","series-title":"Pediatr Neurol","first-page":"742","article-title":"Sympathetic storms in a child with a midbrain glioma: a variant of diencephalic seizures","volume":"21","author":"Goh","year":"1999","unstructured":"Goh KYConway EJDaRosso RCMuszynski CAEpstein FJ.Sympathetic storms in a child with a midbrain glioma: a variant of diencephalic seizures. Pediatr Neurol. 1999;21(4):742-744."},{"issue":"6","key":"bib15","series-title":"Clin Auton Res","first-page":"378","article-title":"Paroxysmal autonomic instability with dystonia","volume":"17","author":"Srinivasan","year":"2007","unstructured":"Srinivasan SLim CCTThirugnanam U.Paroxysmal autonomic instability with dystonia. Clin Auton Res. 2007;17(6):378-381."},{"issue":"17","key":"bib16","series-title":"J Neurotrauma","first-page":"1515","article-title":"Paroxysmal sympathetic hyperactivity after acquired brain injury: consensus on conceptual definition, nomenclature, and diagnostic criteria","volume":"31","author":"Baguley","year":"2014","unstructured":"Baguley IJPerkes IEFernandez-Ortega JFParoxysmal sympathetic hyperactivity after acquired brain injury: consensus on conceptual definition, nomenclature, and diagnostic criteria. J Neurotrauma. 2014;31(17):1515-1520."},{"issue":"6","key":"bib17","series-title":"Ann Neurol","first-page":"609","article-title":"Diencephalic seizures: responsiveness to bromocriptine and morphine","volume":"21","author":"Bullard","year":"1987","unstructured":"Bullard DE.Diencephalic seizures: responsiveness to bromocriptine and morphine. 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Mov Disord. 2006;21(6):868-869."},{"issue":"3","key":"bib20","series-title":"Neurocrit Care","first-page":"217","article-title":"Dexmedetomidine for the treatment of paroxysmal autonomic instability with dystonia","volume":"7","author":"Goddeau","year":"2007","unstructured":"Goddeau RPJrSilverman SBSims JR.Dexmedetomidine for the treatment of paroxysmal autonomic instability with dystonia. Neurocrit Care. 2007;7(3):217-220."},{"issue":"10","key":"bib21","series-title":"Brain Inj","first-page":"1181","article-title":"Paroxysmal sympathetic hyperactivity: autonomic instability and muscle over-activity following severe brain injury","volume":"30","author":"Letzkus","year":"2016","unstructured":"Letzkus LKeim-Malpass JKennedy C.Paroxysmal sympathetic hyperactivity: autonomic instability and muscle over-activity following severe brain injury. Brain Inj. 2016;30(10):1181-1185."},{"issue":"4","key":"bib22","series-title":"Br J Neurosurg","first-page":"471","article-title":"The autonomic dysfunction syndrome: aetiology and treatment","volume":"2","author":"Rossitch","year":"1988","unstructured":"Rossitch EJrBullard DE.The autonomic dysfunction syndrome: aetiology and treatment. Br J Neurosurg. 1988;2(4):471-478."},{"issue":"2","key":"bib23","series-title":"Arch Phys Med Rehabil","first-page":"246","article-title":"Acute hypothalamic instability in traumatic brain injury: a case report","volume":"82","author":"Thorley","year":"2001","unstructured":"Thorley RRWertsch JJKlingbeil GE.Acute hypothalamic instability in traumatic brain injury: a case report. Arch Phys Med Rehabil. 2001;82(2):246-249."},{"issue":"4","key":"bib24","series-title":"Pediatr Neurosurg","first-page":"299","article-title":"A unique pattern of intracranial pressure in a patient with traumatic paroxysmal sympathetic storm","volume":"46","author":"Woo","year":"2010","unstructured":"Woo HJPark SHHwang SK.A unique pattern of intracranial pressure in a patient with traumatic paroxysmal sympathetic storm. Pediatr Neurosurg. 2010;46(4):299-302."},{"issue":"1","key":"bib25","series-title":"J Neurol Sci","first-page":"77","article-title":"Adult aqueduct stenosis and diencephalic epilepsy. A case report","volume":"71","author":"Bhigjee","year":"1985","unstructured":"Bhigjee AIAmes FRRutherford GS.Adult aqueduct stenosis and diencephalic epilepsy. A case report. J Neurol Sci. 1985;71(1):77-89."},{"issue":"6","key":"bib26","series-title":"Neurol India","first-page":"906","article-title":"Diagnosing paroxysmal autonomic instability with dystonia following intracerebral hemorrhage","volume":"59","author":"Chittiboina","year":"2011","unstructured":"Chittiboina PNixon MNanda AGuthikonda B.Diagnosing paroxysmal autonomic instability with dystonia following intracerebral hemorrhage. Neurol India. 2011;59(6):906-908."},{"issue":"1","key":"bib27","series-title":"Childs Brain","first-page":"31","article-title":"Hypothalamic symptomatology and its relationship to diencephalic tumor in childhood","volume":"3","author":"Connors","year":"1977","unstructured":"Connors MHSheikholislam BM.Hypothalamic symptomatology and its relationship to diencephalic tumor in childhood. Childs Brain. 1977;3(1):31-36."},{"issue":"4","key":"bib28","series-title":"Childs Nerv Syst","first-page":"252","article-title":"Diencephalic epilepsy with congenital suprasellar arachnoid cyst in an infant","volume":"4","author":"Giroud","year":"1988","unstructured":"Giroud MSautreaux JLThierry ADumas R.Diencephalic epilepsy with congenital suprasellar arachnoid cyst in an infant. Childs Nerv Syst. 1988;4(4):252-254."},{"key":"bib29","series-title":"J Med Case Rep","first-page":"304","article-title":"Paroxysmal autonomic instability with dystonia in a patient with tuberculous meningitis: a case report","volume":"4","author":"Ramdhani","year":"2010","unstructured":"Ramdhani NASikma MAWitkamp TDSlooter AJde Lange DW.Paroxysmal autonomic instability with dystonia in a patient with tuberculous meningitis: a case report. J Med Case Rep. 2010;4:304."},{"key":"bib30","series-title":"Case Rep Med","first-page":"965932","article-title":"Paroxysmal autonomic instability with dystonia after pneumococcal meningoencephalitis","volume":"2012","author":"Safadieh","year":"2012","unstructured":"Safadieh LSharara-Chami RDabbagh O.Paroxysmal autonomic instability with dystonia after pneumococcal meningoencephalitis. Case Rep Med. 2012;2012:965932."},{"issue":"4","key":"bib31","series-title":"Pediatr Neurosurg","first-page":"275","article-title":"Paroxysmal autonomic instability with dystonia in a child: rare manifestation of an interpeduncular tuberculoma","volume":"47","author":"Singh","year":"2011","unstructured":"Singh DKSingh N.Paroxysmal autonomic instability with dystonia in a child: rare manifestation of an interpeduncular tuberculoma. Pediatr Neurosurg. 2011;47(4):275-278."},{"issue":"2","key":"bib32","series-title":"J Pediatr","first-page":"277","article-title":"Diencephalic autonomic epilepsy caused by a neoplasm","volume":"83","author":"Solomon","year":"1973","unstructured":"Solomon GE.Diencephalic autonomic epilepsy caused by a neoplasm. J Pediatr. 1973;83(2):277-280."},{"issue":"2","key":"bib33","series-title":"Cureus","first-page":"e6933","article-title":"Paroxysmal sympathetic hyperactivity in a young male with glioblastoma multiforme","volume":"12","author":"Suliman","year":"2020","unstructured":"Suliman MSDobariya VShehata MSingh DAl-Astal A.Paroxysmal sympathetic hyperactivity in a young male with glioblastoma multiforme. Cureus. 2020;12(2):e6933."},{"issue":"10","key":"bib34","series-title":"Reg Anesth Pain Med","first-page":"522","article-title":"Stellate ganglion block catheter for paroxysmal sympathetic hyperactivity: calming the \u201cneuro-storm","volume":"48","author":"Lee","year":"2023","unstructured":"Lee MCBartuska AChen JKim RKJaradeh SMihm F.Stellate ganglion block catheter for paroxysmal sympathetic hyperactivity: calming the \u201cneuro-storm.\u201d Reg Anesth Pain Med. 2023;48(10):522-525."},{"issue":"11-12","key":"bib35","series-title":"J Child Neurol","first-page":"403","article-title":"Paroxysmal sympathetic hyperactivity in childhood tuberculous meningitis: a new association","volume":"39","author":"Jauhari","year":"2024","unstructured":"Jauhari PSingh SJain AParoxysmal sympathetic hyperactivity in childhood tuberculous meningitis: a new association. J Child Neurol. 2024;39(11-12):403-408."},{"issue":"6","key":"bib36","series-title":"Anesth Analg","first-page":"1450","article-title":"Autonomic dysfunction secondary to intracerebral hemorrhage","volume":"91","author":"Tong","year":"2000","unstructured":"Tong CYK\u00f6nig MWRoberts PRTatter SBLi XH.Autonomic dysfunction secondary to intracerebral hemorrhage. Anesth Analg. 2000;91(6):1450-1451."},{"issue":"4","key":"bib37","series-title":"J Neurosurg Pediatr","first-page":"282","article-title":"Weathering the storm: a single-institution experience with paroxysmal sympathetic hyperactivity after brain tumor resection in pediatric patients","volume":"31","author":"Bouchal","year":"2023","unstructured":"Bouchal SMNaylor RMDaniels DJ.Weathering the storm: a single-institution experience with paroxysmal sympathetic hyperactivity after brain tumor resection in pediatric patients. J Neurosurg Pediatr. 2023;31(4):282-289."},{"issue":"1","key":"bib38","series-title":"Arch NeurPsych","first-page":"189","article-title":"Autonomic epilepsy\u2014report of a case with observations at necropsy","volume":"32","author":"McLean","year":"1934","unstructured":"McLean AJ.Autonomic epilepsy\u2014report of a case with observations at necropsy. Arch NeurPsych. 1934;32(1):189-197."},{"issue":"1","key":"bib39","series-title":"Arch NeurPsych","first-page":"37","article-title":"Hypothalamic attacks with thalamic lesion. I. Physiologic and psychologic considerations","volume":"54","author":"Engel","year":"1945","unstructured":"Engel GLAring CD.Hypothalamic attacks with thalamic lesion. I. Physiologic and psychologic considerations. Arch NeurPsych. 1945;54(1):37-43."},{"issue":"9","key":"bib40","series-title":"Arch Neurol","first-page":"1037","article-title":"A hyperthermic syndrome in two subjects with acute hydrocephalus","volume":"45","author":"Talman","year":"1988","unstructured":"Talman WTFlorek GBullard DE.A hyperthermic syndrome in two subjects with acute hydrocephalus. Arch Neurol. 1988;45(9):1037-1040."},{"key":"bib41","series-title":"Neuroanatomy Through Clinical Cases","author":"Blumenfeld","year":"2010","unstructured":"Blumenfeld H.Neuroanatomy Through Clinical Cases. 2nd ed. Sinauer Associates; 2010."},{"issue":"2","key":"bib42","series-title":"Mayo Clin Proc","first-page":"148","article-title":"Paroxysmal sympathetic storms (\u201cdiencephalic seizures\u201d) after severe diffuse axonal head injury","volume":"73","author":"Boeve","year":"1998","unstructured":"Boeve BFWijdicks EFBenarroch EESchmidt KD.Paroxysmal sympathetic storms (\u201cdiencephalic seizures\u201d) after severe diffuse axonal head injury. Mayo Clin Proc. 1998;73(2):148-152."},{"issue":"1","key":"bib43","series-title":"J Neurol Neurosurg Psychiatry","first-page":"21","article-title":"Periaqueductal dysfunction (the Sylvian aqueduct syndrome): a sign of hydrocephalus?","volume":"37","author":"Swash","year":"1974","unstructured":"Swash M.Periaqueductal dysfunction (the Sylvian aqueduct syndrome): a sign of hydrocephalus? J Neurol Neurosurg Psychiatry. 1974;37(1):21-26."},{"issue":"3","key":"bib44","series-title":"Surg Neurol","first-page":"187","article-title":"The physics of the cranial cavity, hydrocephalus and normal pressure hydrocephalus: mechanical interpretation and mathematical model","volume":"5","author":"Hakim","year":"1976","unstructured":"Hakim SVenegas JGBurton JD.The physics of the cranial cavity, hydrocephalus and normal pressure hydrocephalus: mechanical interpretation and mathematical model. Surg Neurol. 1976;5(3):187-210."},{"issue":"6","key":"bib1","series-title":"J Neurosurg","first-page":"1773","article-title":"The clinical spectrum of hydrocephalus in adults: report of the first 517 patients of the Adult Hydrocephalus Clinical Research Network registry","volume":"132","author":"Williams","year":"2020","unstructured":"Williams MANagel SJLuciano MGThe clinical spectrum of hydrocephalus in adults: report of the first 517 patients of the Adult Hydrocephalus Clinical Research Network registry. J Neurosurg. 2020;132(6):1773-1784."},{"issue":"3","key":"bib2","series-title":"J Neurosurg","first-page":"887","article-title":"Cognitive and gait outcomes after primary endoscopic third ventriculostomy in adults with chronic obstructive hydrocephalus","volume":"136","author":"Zwimpfer","year":"2022","unstructured":"Zwimpfer TJSalterio NWilliams MACognitive and gait outcomes after primary endoscopic third ventriculostomy in adults with chronic obstructive hydrocephalus. 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Dev Med Child Neurol. 1967:4-13."},{"issue":"2","key":"bib5","series-title":"Pediatr Neurosurg","first-page":"101","article-title":"An approach to the management of arrested and compensated hydrocephalus","volume":"19","author":"McLone","year":"1993","unstructured":"McLone DGAronyk KE.An approach to the management of arrested and compensated hydrocephalus. Pediatr Neurosurg. 1993;19(2):101-103."},{"issue":"2","key":"bib6","series-title":"Acta Neurol Scand","first-page":"81","article-title":"Adult patients with \u201casymptomatic\u201d and \u201ccompensated\u201d hydrocephalus benefit from surgery","volume":"99","author":"Larsson","year":"1999","unstructured":"Larsson AStephensen HWikkels\u00f8 C.Adult patients with \u201casymptomatic\u201d and \u201ccompensated\u201d hydrocephalus benefit from surgery. Acta Neurol Scand. 1999;99(2):81-90."},{"key":"bib7","series-title":"Clin Neurol Neurosurg","first-page":"79","article-title":"Surgical management of arrested hydrocephalus: case report, literature review, and 18-month follow-up","volume":"151","author":"Hong","year":"2016","unstructured":"Hong JBarrena BGLollis SSBauer DF.Surgical management of arrested hydrocephalus: case report, literature review, and 18-month follow-up. Clin Neurol Neurosurg. 2016;151:79-85."},{"issue":"6","key":"bib8","series-title":"Int J Legal Med","first-page":"331","article-title":"Sudden unexpected death in young adults with chronic hydrocephalus","volume":"114","author":"Rickert","year":"2001","unstructured":"Rickert CHGrabellus FVarchmin-Schultheiss KSt\u00f6ss HPaulus W.Sudden unexpected death in young adults with chronic hydrocephalus. Int J Legal Med. 2001;114(6):331-337."},{"issue":"4","key":"bib9","series-title":"Childs Nerv Syst","first-page":"249","article-title":"Rapid neurological deterioration associated with minor head trauma in chronic hydrocephalus","volume":"19","author":"Dickerman","year":"2003","unstructured":"Dickerman RDMcConathy WJLustrin ESchneider SJ.Rapid neurological deterioration associated with minor head trauma in chronic hydrocephalus. Childs Nerv Syst. April 2003;19(4):249-253."},{"issue":"3","key":"bib10","series-title":"Brain Pathol","first-page":"325","article-title":"Chronic hydrocephalus in adults","volume":"14","author":"Edwards","year":"2004","unstructured":"Edwards RJDombrowski SMLuciano MGPople IK.Chronic hydrocephalus in adults. Brain Pathol. 2004;14(3):325-336."},{"issue":"9","key":"bib11","series-title":"Lancet Neurol","first-page":"721","article-title":"Paroxysmal sympathetic hyperactivity: the storm after acute brain injury","volume":"16","author":"Meyfroidt","year":"2017","unstructured":"Meyfroidt GBaguley IJMenon DK.Paroxysmal sympathetic hyperactivity: the storm after acute brain injury. Lancet Neurol. 2017;16(9):721-729."},{"issue":"3","key":"bib12","series-title":"Arch Neurol","first-page":"321","article-title":"Paroxysmal autonomic instability with dystonia after brain injury","volume":"61","author":"Blackman","year":"2004","unstructured":"Blackman JAPatrick PDBuck MLRust RSJr.Paroxysmal autonomic instability with dystonia after brain injury. 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Pediatr Neurol. 1999;21(4):742-744."},{"issue":"6","key":"bib15","series-title":"Clin Auton Res","first-page":"378","article-title":"Paroxysmal autonomic instability with dystonia","volume":"17","author":"Srinivasan","year":"2007","unstructured":"Srinivasan SLim CCTThirugnanam U.Paroxysmal autonomic instability with dystonia. Clin Auton Res. 2007;17(6):378-381."},{"issue":"17","key":"bib16","series-title":"J Neurotrauma","first-page":"1515","article-title":"Paroxysmal sympathetic hyperactivity after acquired brain injury: consensus on conceptual definition, nomenclature, and diagnostic criteria","volume":"31","author":"Baguley","year":"2014","unstructured":"Baguley IJPerkes IEFernandez-Ortega JFParoxysmal sympathetic hyperactivity after acquired brain injury: consensus on conceptual definition, nomenclature, and diagnostic criteria. J Neurotrauma. 2014;31(17):1515-1520."},{"issue":"6","key":"bib17","series-title":"Ann Neurol","first-page":"609","article-title":"Diencephalic seizures: responsiveness to bromocriptine and morphine","volume":"21","author":"Bullard","year":"1987","unstructured":"Bullard DE.Diencephalic seizures: responsiveness to bromocriptine and morphine. Ann Neurol. 1987;21(6):609-611."},{"key":"bib18","series-title":"Tremor Other Hyperkinet Mov (N Y)","article-title":"Paroxysmal autonomic instability with dystonia after severe traumatic brain injury","volume":"10","author":"Cardoso Vale","year":"2020","unstructured":"Cardoso Vale TEchenique LBarsottini OGPPedroso JL.Paroxysmal autonomic instability with dystonia after severe traumatic brain injury. Tremor Other Hyperkinet Mov (N Y). 2020;10:12."},{"issue":"6","key":"bib19","series-title":"Mov Disord","first-page":"868","article-title":"Arc de cercle and dysautonomia from anoxic injury","volume":"21","author":"Diesing","year":"2006","unstructured":"Diesing TSWijdicks EFM.Arc de cercle and dysautonomia from anoxic injury. Mov Disord. 2006;21(6):868-869."},{"issue":"3","key":"bib20","series-title":"Neurocrit Care","first-page":"217","article-title":"Dexmedetomidine for the treatment of paroxysmal autonomic instability with dystonia","volume":"7","author":"Goddeau","year":"2007","unstructured":"Goddeau RPJrSilverman SBSims JR.Dexmedetomidine for the treatment of paroxysmal autonomic instability with dystonia. Neurocrit Care. 2007;7(3):217-220."},{"issue":"10","key":"bib21","series-title":"Brain Inj","first-page":"1181","article-title":"Paroxysmal sympathetic hyperactivity: autonomic instability and muscle over-activity following severe brain injury","volume":"30","author":"Letzkus","year":"2016","unstructured":"Letzkus LKeim-Malpass JKennedy C.Paroxysmal sympathetic hyperactivity: autonomic instability and muscle over-activity following severe brain injury. Brain Inj. 2016;30(10):1181-1185."},{"issue":"4","key":"bib22","series-title":"Br J Neurosurg","first-page":"471","article-title":"The autonomic dysfunction syndrome: aetiology and treatment","volume":"2","author":"Rossitch","year":"1988","unstructured":"Rossitch EJrBullard DE.The autonomic dysfunction syndrome: aetiology and treatment. Br J Neurosurg. 1988;2(4):471-478."},{"issue":"2","key":"bib23","series-title":"Arch Phys Med Rehabil","first-page":"246","article-title":"Acute hypothalamic instability in traumatic brain injury: a case report","volume":"82","author":"Thorley","year":"2001","unstructured":"Thorley RRWertsch JJKlingbeil GE.Acute hypothalamic instability in traumatic brain injury: a case report. Arch Phys Med Rehabil. 2001;82(2):246-249."},{"issue":"4","key":"bib24","series-title":"Pediatr Neurosurg","first-page":"299","article-title":"A unique pattern of intracranial pressure in a patient with traumatic paroxysmal sympathetic storm","volume":"46","author":"Woo","year":"2010","unstructured":"Woo HJPark SHHwang SK.A unique pattern of intracranial pressure in a patient with traumatic paroxysmal sympathetic storm. Pediatr Neurosurg. 2010;46(4):299-302."},{"issue":"1","key":"bib25","series-title":"J Neurol Sci","first-page":"77","article-title":"Adult aqueduct stenosis and diencephalic epilepsy. A case report","volume":"71","author":"Bhigjee","year":"1985","unstructured":"Bhigjee AIAmes FRRutherford GS.Adult aqueduct stenosis and diencephalic epilepsy. A case report. J Neurol Sci. 1985;71(1):77-89."},{"issue":"6","key":"bib26","series-title":"Neurol India","first-page":"906","article-title":"Diagnosing paroxysmal autonomic instability with dystonia following intracerebral hemorrhage","volume":"59","author":"Chittiboina","year":"2011","unstructured":"Chittiboina PNixon MNanda AGuthikonda B.Diagnosing paroxysmal autonomic instability with dystonia following intracerebral hemorrhage. Neurol India. 2011;59(6):906-908."},{"issue":"1","key":"bib27","series-title":"Childs Brain","first-page":"31","article-title":"Hypothalamic symptomatology and its relationship to diencephalic tumor in childhood","volume":"3","author":"Connors","year":"1977","unstructured":"Connors MHSheikholislam BM.Hypothalamic symptomatology and its relationship to diencephalic tumor in childhood. Childs Brain. 1977;3(1):31-36."},{"issue":"4","key":"bib28","series-title":"Childs Nerv Syst","first-page":"252","article-title":"Diencephalic epilepsy with congenital suprasellar arachnoid cyst in an infant","volume":"4","author":"Giroud","year":"1988","unstructured":"Giroud MSautreaux JLThierry ADumas R.Diencephalic epilepsy with congenital suprasellar arachnoid cyst in an infant. Childs Nerv Syst. 1988;4(4):252-254."},{"key":"bib29","series-title":"J Med Case Rep","first-page":"304","article-title":"Paroxysmal autonomic instability with dystonia in a patient with tuberculous meningitis: a case report","volume":"4","author":"Ramdhani","year":"2010","unstructured":"Ramdhani NASikma MAWitkamp TDSlooter AJde Lange DW.Paroxysmal autonomic instability with dystonia in a patient with tuberculous meningitis: a case report. J Med Case Rep. 2010;4:304."},{"key":"bib30","series-title":"Case Rep Med","first-page":"965932","article-title":"Paroxysmal autonomic instability with dystonia after pneumococcal meningoencephalitis","volume":"2012","author":"Safadieh","year":"2012","unstructured":"Safadieh LSharara-Chami RDabbagh O.Paroxysmal autonomic instability with dystonia after pneumococcal meningoencephalitis. Case Rep Med. 2012;2012:965932."},{"issue":"4","key":"bib31","series-title":"Pediatr Neurosurg","first-page":"275","article-title":"Paroxysmal autonomic instability with dystonia in a child: rare manifestation of an interpeduncular tuberculoma","volume":"47","author":"Singh","year":"2011","unstructured":"Singh DKSingh N.Paroxysmal autonomic instability with dystonia in a child: rare manifestation of an interpeduncular tuberculoma. Pediatr Neurosurg. 2011;47(4):275-278."},{"issue":"2","key":"bib32","series-title":"J Pediatr","first-page":"277","article-title":"Diencephalic autonomic epilepsy caused by a neoplasm","volume":"83","author":"Solomon","year":"1973","unstructured":"Solomon GE.Diencephalic autonomic epilepsy caused by a neoplasm. J Pediatr. 1973;83(2):277-280."},{"issue":"2","key":"bib33","series-title":"Cureus","first-page":"e6933","article-title":"Paroxysmal sympathetic hyperactivity in a young male with glioblastoma multiforme","volume":"12","author":"Suliman","year":"2020","unstructured":"Suliman MSDobariya VShehata MSingh DAl-Astal A.Paroxysmal sympathetic hyperactivity in a young male with glioblastoma multiforme. Cureus. 2020;12(2):e6933."},{"issue":"10","key":"bib34","series-title":"Reg Anesth Pain Med","first-page":"522","article-title":"Stellate ganglion block catheter for paroxysmal sympathetic hyperactivity: calming the \u201cneuro-storm","volume":"48","author":"Lee","year":"2023","unstructured":"Lee MCBartuska AChen JKim RKJaradeh SMihm F.Stellate ganglion block catheter for paroxysmal sympathetic hyperactivity: calming the \u201cneuro-storm.\u201d Reg Anesth Pain Med. 2023;48(10):522-525."},{"issue":"11-12","key":"bib35","series-title":"J Child Neurol","first-page":"403","article-title":"Paroxysmal sympathetic hyperactivity in childhood tuberculous meningitis: a new association","volume":"39","author":"Jauhari","year":"2024","unstructured":"Jauhari PSingh SJain AParoxysmal sympathetic hyperactivity in childhood tuberculous meningitis: a new association. J Child Neurol. 2024;39(11-12):403-408."},{"issue":"6","key":"bib36","series-title":"Anesth Analg","first-page":"1450","article-title":"Autonomic dysfunction secondary to intracerebral hemorrhage","volume":"91","author":"Tong","year":"2000","unstructured":"Tong CYK\u00f6nig MWRoberts PRTatter SBLi XH.Autonomic dysfunction secondary to intracerebral hemorrhage. Anesth Analg. 2000;91(6):1450-1451."},{"issue":"4","key":"bib37","series-title":"J Neurosurg Pediatr","first-page":"282","article-title":"Weathering the storm: a single-institution experience with paroxysmal sympathetic hyperactivity after brain tumor resection in pediatric patients","volume":"31","author":"Bouchal","year":"2023","unstructured":"Bouchal SMNaylor RMDaniels DJ.Weathering the storm: a single-institution experience with paroxysmal sympathetic hyperactivity after brain tumor resection in pediatric patients. J Neurosurg Pediatr. 2023;31(4):282-289."},{"issue":"1","key":"bib38","series-title":"Arch NeurPsych","first-page":"189","article-title":"Autonomic epilepsy\u2014report of a case with observations at necropsy","volume":"32","author":"McLean","year":"1934","unstructured":"McLean AJ.Autonomic epilepsy\u2014report of a case with observations at necropsy. Arch NeurPsych. 1934;32(1):189-197."},{"issue":"1","key":"bib39","series-title":"Arch NeurPsych","first-page":"37","article-title":"Hypothalamic attacks with thalamic lesion. I. Physiologic and psychologic considerations","volume":"54","author":"Engel","year":"1945","unstructured":"Engel GLAring CD.Hypothalamic attacks with thalamic lesion. I. Physiologic and psychologic considerations. Arch NeurPsych. 1945;54(1):37-43."},{"issue":"9","key":"bib40","series-title":"Arch Neurol","first-page":"1037","article-title":"A hyperthermic syndrome in two subjects with acute hydrocephalus","volume":"45","author":"Talman","year":"1988","unstructured":"Talman WTFlorek GBullard DE.A hyperthermic syndrome in two subjects with acute hydrocephalus. Arch Neurol. 1988;45(9):1037-1040."},{"key":"bib41","series-title":"Neuroanatomy Through Clinical Cases","author":"Blumenfeld","year":"2010","unstructured":"Blumenfeld H.Neuroanatomy Through Clinical Cases. 2nd ed. Sinauer Associates; 2010."},{"issue":"2","key":"bib42","series-title":"Mayo Clin Proc","first-page":"148","article-title":"Paroxysmal sympathetic storms (\u201cdiencephalic seizures\u201d) after severe diffuse axonal head injury","volume":"73","author":"Boeve","year":"1998","unstructured":"Boeve BFWijdicks EFBenarroch EESchmidt KD.Paroxysmal sympathetic storms (\u201cdiencephalic seizures\u201d) after severe diffuse axonal head injury. Mayo Clin Proc. 1998;73(2):148-152."},{"issue":"1","key":"bib43","series-title":"J Neurol Neurosurg Psychiatry","first-page":"21","article-title":"Periaqueductal dysfunction (the Sylvian aqueduct syndrome): a sign of hydrocephalus?","volume":"37","author":"Swash","year":"1974","unstructured":"Swash M.Periaqueductal dysfunction (the Sylvian aqueduct syndrome): a sign of hydrocephalus? J Neurol Neurosurg Psychiatry. 1974;37(1):21-26."},{"issue":"3","key":"bib44","series-title":"Surg Neurol","first-page":"187","article-title":"The physics of the cranial cavity, hydrocephalus and normal pressure hydrocephalus: mechanical interpretation and mathematical model","volume":"5","author":"Hakim","year":"1976","unstructured":"Hakim SVenegas JGBurton JD.The physics of the cranial cavity, hydrocephalus and normal pressure hydrocephalus: mechanical interpretation and mathematical model. Surg Neurol. 1976;5(3):187-210."}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/9\/22\/article-CASE2547.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/9\/22\/article-CASE2547.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/9\/22\/article-CASE2547.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T23:37:26Z","timestamp":1770075446000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/9\/22\/article-CASE2547.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,2]]},"references-count":88,"journal-issue":{"issue":"22"},"URL":"https:\/\/doi.org\/10.3171\/case2547","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,2]]}}}