Diencephalic storms from leptomeningeal metastases and leukoencephalopathy: a rare and clinically important complication

Am J Hosp Palliat Care. 2014 Feb;31(1):98-100. doi: 10.1177/1049909112472047. Epub 2013 Jan 8.


Diencephalic storms or paroxysmal sympathetic storms are characterized by episodic hyperhidrosis, hypertension, tachypnea, tachycardia, and abnormal posturing. These have been reported to occur in patients with hydrocephalus, intracranial tumors, and hypoxic, ischemic, or traumatic brain injury. They can be easily misdiagnosed as seizures, uncontrolled pheochromocytoma, drug withdrawal, thyroid storm, hypertensive crises, and sepsis or anxiety attacks. The most effective treatment to control these symptoms is yet to be identified. We present 2 individuals exhibiting these sympathetic surges; one whose symptoms were controlled with phenobarbital and the other with clonidine and oxycodone. Palliative medicine physicians should be made aware of this unusual complication.

Keywords: diencephalic; epilepsy; leptomeningeal; sympathetic.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anticonvulsants / therapeutic use
  • Female
  • Humans
  • Leukoencephalopathies / complications*
  • Male
  • Meningeal Neoplasms / complications*
  • Seizures / drug therapy
  • Seizures / etiology*


  • Anticonvulsants