Paroxysmal Sympathetic Hyperactivity (Sympathetic Storm) in a Patient with Permanent Vegetative State

Abstract

Paroxysmal sympathetic hyperactivity is a relatively common complication early in the course of traumatic brain injury. Recognition of the clinical presentation of this syndrome is important to palliative and hospice care providers who may be caring for patients with PVS. The treatment of sympathic hyperactivity to reduce potential physical suffering includes medications targeted to the sympathetic nervous system.

Paroxysmal sympathetic hyperactivity: the storm after acute brain injury

“…It may be less appropriate for paroxysmal symptoms, since it may potentiate hypotension and bradycardia between paroxysms, making titration challenging. 36 However, clonidine patches can be effective in controlling the storms, even late in the course of the patient 40 . Dexmedetomidine has also been reported to be effective in managing PSH in the ICU 41,42 .…”

Paroxysmal Sympathetic Hyperactivity in a Young Male with Glioblastoma Multiforme

“…PSH has been reported in conditions other than TBI. These include hypoxic brain injuries, brain tumors, hydrocephalus, and subarachnoid hemorrhages [2]. Although the pathophysiology of PSH is not known, it has been postulated as a result of the disinhibition of the central sympathoexcitatory regions, leading to catecholamine release and a subsequent hyperadrenergic state [6].…”

“…Suggested medications include clonidine, dantrolene, lorazepam, morphine sulfate, and nonselective beta-blockers. These may be used individually or in combination [2]. In our patient, a symptom triggered approach was pursued once the diagnosis was established and, eventually, palliation was decided upon by the family.…”

“…For decades, these vital sign fluctuations were hypothesized to stem from increased pressure on the thalamus. Originally termed diencephalic autonomic seizures by Dr. Wilder Penfield in 1929, paroxysmal sympathetic hyperactivity (PSH) is now known to be a well-recognized syndrome as a result of severe brain injury [1][2]. PSH is characterized by episodic hypertension, hyperthermia, tachycardia, tachypnea, diaphoresis, and extensor posturing.…”

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

“…Other medications included dopamine receptor agonists (eg bromocriptine), non-selective beta-blockers (eg propranolol), α2-adrenergic receptor agonists (clonidine), benzodiazepines, muscle relaxants, dopamine (eg levodopa), GABA drugs (eg gabapentin and baclofen), etc. In most cases, they needed to be taken together (12,14,16,17). Small sample studies suggested that HBOT can serve as an auxiliary means of medication (18).…”