Paroxysmal sympathetic hyperactivity in neurological critical care

Abstract

Introduction:Paroxysmal sympathetic hyperactivity (PSH) is a clinical disorder mainly caused by traumatic brain injury, stroke, encephalitis and other types of brain injury. The clinical features are episodes of hypertension, tachycardia, tachypnea, fever and dystonic postures. In this study, we described clinical profile and outcome of six patients of PSH admitted in neurocritical care unit.Materials and Methods:This was a prospective observational study conducted at neurology critical care unit of a tertiary care center. All patients admitted at neurology critical unit during 6-month period from August 2013 to January 2014 were screened for the occurrence of PSH. The clinical details and outcome was documented.Results:PSH was observed in 6 patients. Male to female ratio was 5:1. Mean age ± SD was 36.67 ± 15.19 years. The leading causes were traumatic brain injury (two patients), stroke (two patients) and Japanese encephalitis (JE) (one patient) and tuberculous meningitis (one patient).Conclusion:PSH is an unusual complication in neurocritical care. It prolonged the hospitalization and hampers recovery. The other life-threatening conditions that mimic PSH should be excluded. The association with JE and tuberculous meningitis was not previously described in literature.

Identification and Management of Paroxysmal Sympathetic Hyperactivity After Traumatic Brain Injury

“…Although the outbreaks of PSH were traditionally described in severe acquired brain injury (ABI) patients [e.g., traumatic brain injury (TBI), anoxic brain injury, stroke, tumors, infections, or unspecified causes], the prevalence of PSH of 33% after TBI compared with 6% after other causes suggests that the dominant underlying cause in PSH is TBI (4). In addition, in the past decade, about 80% of PSH cases have been reported to occur after TBI (5,6). Its wide incidence rates reported ranging from 8 to 33% of PSH reveal the underlying discrepancy of current diagnostic and admission criteria as well as ignorance on disease identification (7).…”