• John Kern, Daniel Bodek, Osama Tariq Niazi, and James Maher.
• Department of Internal Medicine, Rutgers University, New Jersey Medical School, Newark, NJ. Electronic address: johnkerndo@gmail.com.
• Chest. 2016 Feb 1; 149 (2): e39-40.

AbstractParoxysmal autonomic instability with dystonia (PAID) is a syndrome commonly related to traumatic brain injury (TBI) and rarely to anoxia associated with symptoms of dystonia, tachycardia, tachypnea, and diaphoresis. This is a case of a 20-year-old man who was stabbed in the heart. He underwent surgical repair of a ventricular septal defect and mitral valve replacement. Postoperatively, he developed dystonia with tachycardia and tachypnea consistent with PAID syndrome, secondary to prolonged hypoxia. Traditionally, this poorly understood syndrome is treated with morphine, clonazepam, and nonselective β-blockers. Second-line medications commonly used are baclofen, dantrolene, and gabapentin, which are aimed at the dystonia itself. In this case, both first- and second-line agents were ineffective. A 72-hour dexmedetomidine infusion resulted in complete resolution of symptoms. This is the first case of anoxia-induced PAID syndrome to be effectively treated with dexmedetomidine, which was previously used in a case induced by TBI.Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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