Sympathetic storm or Cytokine storm: A diagnostic dilemma in patient of traumatic brain injury with COVID 19.

Purpose: Paroxysmal sympathetic hyperactivity (PSH) occurs in around 15-33% patients of traumatic brain injury. Due to presence of non-specific symptoms, it's always difficult to differentiate between paroxysmal sympathetic storm and cytokine storm syndrome and hence can delay specific treatment.

Case report: We report a clinical case of 19-year-old male tested COVID 19 positive with diffuse axonal injury presented with features of paroxysmal sympathetic storm and cytokine storm syndrome. The patient showed the signs clinical improvement when we treated both these conditions.

Conclusion: We suggest that clinicians need to have a high degree of suspicion of paroxysmal sympathetic storm in patients of traumatic brain injury and consider its diagnosis. Also, if patient is COVID 19 positive, early identification of signs of developing cytokine storm with monitoring of biomarkers is important for its timely management.