• Richard P Goddeau, Scott B Silverman, and John R Sims.
• Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA.
• Neurocrit Care. 2007 Jan 1;7(3):217-20.

IntroductionA 38-year-old man with severe head trauma complicated by paroxysmal severe intracranial pressure elevation associated with tachypnea, tachycardia, diaphoresis, and extensor posturing was diagnosed as suffering from paroxysmal autonomic instability with dystonia (PAID). These events were unresponsive to standard medical therapy, which included morphine, fentanyl, labetalol, lorazepam, metoprolol, and clonidine.MethodsA trial treatment with dexmedetomidine, a central acting alpha2-agonist, to control symptoms of PAID was initiated 12 days after injury. PAID-related events subsided during the 72-h infusion protocol of 0.2-0.7 mcg/kg/h. No further events were noted after termination of the 72-h infusion.ConclusionsDexmedetomidine may be a novel pharmacologic agent to aid in abrogating PAID.

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