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Current Neurology and Neuroscience Reports
Published in: Current Neurology and Neuroscience Reports 11/2014

01-11-2014 | Neurotrauma (J Levine, Section Editor)

Paroxysmal Sympathetic Hyperactivity after Severe Brain Injury

Authors: Devon Lump, Megan Moyer

Published in: Current Neurology and Neuroscience Reports | Issue 11/2014

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Abstract

Paroxysmal sympathetic hyperactivity (PSH) is characterized by the rapid onset and paroxysmal cycling of agitation and dystonia in association with autonomic symptoms. These symptoms may include the following: tachycardia, hypertension, tachypnea, fever, pupil dilation, decreased level of consciousness, diaphoresis, and ventilator dyssynchrony. In a critically ill patient, these are all nonspecific symptoms that may reflect impending sepsis, seizure, or a number of other complications. This can confound and delay the diagnosis and treatment of PSH. While this phenomenon has been frequently observed in the traumatic brain injured population, management is highly variable, prompting this review of the literature. This article aims to outline the evidence base for the management of PSH, as well as to describe an algorithm for management developed at our institution.
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Hughes JD, Rabinstein AA. Early diagnosis of paroxysmal hyperactivity in the ICU. Neurocrit Care. 2013. Hughes et al. retrospectively reviewed electronic medical records of critically ill patients with acquired brain injury from 2006–2012 who demonstrated PSH. Fifty-three patients were identified as having PSH. Individual patient records were evaluated to ascertain which PSH symptoms were noted to support the diagnosis. Eighty-nine percent of patients who were clinically diagnosed with PSH also met the formal diagnostic criteria, thus, validating PSH can be accurately diagnosed in the ICU and strict diagnostic criteria generally supports the clinician’s insight.
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Fernandez-Ortega JF, Prieto-Palomina MA, Garcia-Caballero M, Galeas-Lopez J, Quesada-Garcia G, Baguley IJ. Paroxysmal sympathetic hyperactivity after traumatic brain injury: clinical and prognostic implications. J Neurotrauma. 2012;29:1364–70. Fernandez-Ortega et al. published a prospective study, in which they evaluated all ICU severe TBI admissions over an 18-month period of time, identifying 10.1% who experienced PSH. It was noted that the PSH study group had a greater length of ICU stay, higher prevalence of infections, more time spent on mechanical ventilation, higher incidence of tracheostomy placement, and longer course of hospitalization.PubMedCrossRef
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Metadata
Title
Paroxysmal Sympathetic Hyperactivity after Severe Brain Injury
Authors
Devon Lump
Megan Moyer
Publication date
01-11-2014
Publisher
Springer US
Published in
Current Neurology and Neuroscience Reports / Issue 11/2014
Print ISSN: 1528-4042
Electronic ISSN: 1534-6293
DOI
https://doi.org/10.1007/s11910-014-0494-0

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