Paroxysmal Sympathetic Hyperactivity After Acute Brain Injury

Abstract

Paroxysmal sympathetic hyperactivity is a syndrome associated with brain trauma, stroke, encephalitis, and other forms of brain injury. It is characterized by uncontrolled episodes of unbalanced sympathetic surges causing hyperthermia, diaphoresis, tachycardia, hypertension, tachypnea, and dystonic posturing. Patients who develop paroxysmal sympathetic hyperactivity have worse neurologic outcomes, longer hospital stays, and more complications. Despite the clear negative impact on outcome, consensus regarding diagnostic criteria, risk factors, pathophysiology, and treatment approaches is lacking. Recently, the importance of consensus regarding diagnostic criteria has been emphasized, and new theories of pathophysiology have been proposed. Many treatment options are available, but only a few systemic studies of the efficacy of treatment algorithms exist. Treatments should focus on decreasing the frequency and intensity of episodes with regularly scheduled doses of medications, such as long-acting benzodiazepines, nonselective β-blockers, α2-agonists, morphine, baclofen, and gabapentin, usually in combination. Treatment of acute breakthrough episodes should focus on doses of as-needed morphine and short-acting benzodiazepines. A balance between control of symptoms without oversedation is the goal.

Paroxysmal Sympathetic Hyperactivity in a Child with Tuberculous Meningitis: A Case Study and Review of Related Literature

“…Therefore, the early literature used the term "diencephalic epilepsy" but abandoned it later (11). Besides, PSH also needed to be distinguished from malignant syndromes, loss of autonomic spinal neural reflex, sepsis, hyperthyroidism, central high fever and withdrawal syndromes, etc (12,13).…”

Treatment Progress of Paroxysmal Sympathetic Hyperactivity after Acquired Brain Injury

“…The episode of PSH often makes the condition more complicated. All of the existing treatment strategies for PSH are from case reports or case series, but the methodological quality of the evidence is very low [23,24]. There are two limitations for treatment development of PSH [5].…”

“…So far, treatments for PSH generally focus on the control of symptoms [23]. Generally speaking, there are three therapeutic measures for PSH.…”

“…Choi et al [23] recommended that intravenously administered morphine should be considered first followed by a switch to oral administration with a scheduled route. Generally speaking, 8 mg intravenously during the episode of PSH is enough, but the specific appropriate dose should be according to individual responses.…”

Clinical Scales for Paroxysmal Sympathetic Hyperactivity in Pediatric Patients

“…This systematization will hopefully lead to a rationalization of drug therapies that, in the field of PSH, are currently carried out based on isolated observations. [3][4][5] Ideally, a large multicentric study should be performed.…”