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October 2004

Paroxysmal Autonomic Instability After Brain Injury—Reply

Arch Neurol. 2004;61(10):1625. doi:10.1001/archneur.61.10.1625-b

In reply

Dr Rabinstein makes a valid point in suggesting that our criteria for autonomic dysregulation after brain injury are restrictive. We agree that many patients display only 1 or 2 of the criteria but often not all of them, especially the dystonia. The syndrome we have termed PAID may represent a continuum of signs and symptoms. In a review of our institutional cases of PAID, only about a third of patients with descriptions of “storming” in the attending or resident physician’s notes met the full criteria that we proposed. As Dr Rabinstein restated, it is important to recognize and treat the signs early even if the full-blown syndrome is not manifested.

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