Risk factors and clinical features of paroxysmal sympathetic hyperactivity after spontaneous intracerebral hemorrhage

Liu, Zhenxing; Wen, Chuanbiao; Zhu, Yibai; Han, Kaiwei; Wang, Junyu; Chen, Jigang; Zhang, Danfeng; Yu, Mei; Lv, Liquan; Hou, Lingling

doi:10.1016/j.autneu.2020.102643

Cited by 7 publications

(7 citation statements)

References 30 publications

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“…It is unclear whether the onset of PSH after anti-NMDAR encephalitis presents with unique features compared to acquired brain injury with other etiologies. The most common symptoms of PSH in our cohort were tachycardia (100%), tachypnea (100%) and hypertonia (100%), which contradicts previous reports indicating that PSH after TBI and ICH mainly manifest as hypertonia (94%) and hyperhidrosis (77%) [21], or hyperthermia (80%) and hyperhidrosis (80%) [22].…”

Section: Discussioncontrasting

confidence: 97%

Characteristics and Outcomes of Autonomic Dysfunction in Anti-NMDAR Encephalitis

Chen¹,

Zhang²,

Wu³

et al. 2021

Preprint

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Background To explore the characteristics and prognosis of autonomic dysfunction and paroxysmal sympathetic hyperactivity (PSH), and evaluate the efficacy of drugs used to suppress PSH episode in anti-NMDAR encephalitis patients.MethodsPatients who met the diagnostic criteria of anti-NMDAR encephalitis were enrolled from January 2012 to August 2018 and followed up. PSH was diagnosed according to the PSH-Assessment Measure. The demographics data, clinical features, main accessory examinations, treatments, and long-term outcomes were prospective collected and analyzed. ResultsA total of 132 anti-NMDAR encephalitis patients were enrolled, 27.3% of patients experienced autonomic dysfunction, of which cardiac autonomic dysfunction (77.8%) was the most common subdivisions. Of the patients, 9.1% had probable PSH, tachycardia, tachypnea, and hypertonia (100%) were the most common symptoms of PSH. Patients with a higher incidence of ovarian teratoma, mechanical ventilation, intensive care unit admission, and elevated levels of CSF glucose, and higher CSF NMDAR antibody titers were more likely to exhibit autonomic dysfunction or PSH. Diazepam and phenobarbitone were commonly used drugs to control PSH episodes in patients without prior sedative drugs and the overall efficacy was 90.0%. However, the efficacy of monotherapy dropped to 69.6% and approximately half of episodes need a combination of drugs to control symptoms in PSH patients with prior sedative drugs. No significant difference was observed in the prognosis between the autonomic dysfunction group and the non- autonomic dysfunction group or PSH group and non-PSH group after 6 months and during long-term follow-up. However, patients with cardiac autonomic dysfunction had a poor prognosis at 6 months.Conclusion PSH is a common clinical condition in patients with anti-NMDAR encephalitis, especially in severe cases, and the clinical management of PSH can be assisted by several acute drug administered therapies. Patients with autonomic dysfunction or PSH do not seem to compromise their neurological recovery despite a longer hospital stay.

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Section: Discussioncontrasting

confidence: 97%

Characteristics and Outcomes of Autonomic Dysfunction in Anti-NMDAR Encephalitis

Chen¹,

Zhang²,

Wu³

et al. 2021

Preprint

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“…However, the strict inclusion criteria of this study, in which all patients met the probable PSH, reduced the possibility of misdiagnosis. The most common symptoms of PSH in our cohort were tachycardia (100%), tachypnea (100%) and posturing (100%), which contradicts previous reports indicating that PSH after TBI and ICH mainly manifest as hypertonia (94%) and hyperhidrosis (77%) ( 21 ), or hyperthermia (80%) and hyperhidrosis (80%) ( 26 ).…”

Section: Discussioncontrasting

confidence: 96%

Characteristics and Outcomes of Paroxysmal Sympathetic Hyperactivity in Anti-NMDAR Encephalitis

Chen

Zhang

et al. 2022

Front. Immunol.

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BackgroundTo explore the clinical characteristics and prognosis of autonomic dysfunction and paroxysmal sympathetic hyperactivity (PSH), and evaluate the efficacy of drugs used to suppress PSH episode in anti-NMDAR encephalitis patients.MethodsPatients who met the diagnostic criteria of anti-NMDAR encephalitis were enrolled from January 2012 to August 2018 and followed up for 2 years. PSH was diagnosed according to the PSH-Assessment Measure. The demographics data, clinical features, auxiliary tests results, treatments, and outcomes were prospective collected and analyzed.ResultsA total of 132 anti-NMDAR encephalitis patients were enrolled, of which 27.3% and 9.1% experienced autonomic dysfunction and probable PSH respectively. Cardiac autonomic dysfunction was the most common subtype (77.8%). Patients with a higher incidence of ovarian teratoma, mechanical ventilation, neurological intensive care unit admission, and elevated glucose and NMDAR antibody titer in the CSF were more likely to exhibit autonomic dysfunction or PSH. Episodes of PSH can be suppressed by monotherapy in patients without prior sedative drug use with an efficacy of 90%. No significant difference was observed between the prognosis of patients with or without autonomic dysfunction, or between the PSH versus non-PSH groups after 6 months and even during long-term follow-up. However, patients with cardiac autonomic dysfunction had poor prognosis at 6 months.ConclusionPSH is a common clinical condition in patients with anti-NMDAR encephalitis, especially in severe cases, and can be effectively managed by several drug monotherapies. Despite necessitating longer hospital stay, autonomic dysfunction or PSH do not seem to compromise the neurological recovery of patients.

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“…Li [ 17 ] previously reported that the GCS score of patients with PSH was significantly lower than that of patients without PSH. In our study, The GCS score of 19 patients (79.2%) below 8 on admission.…”

Section: Discussionmentioning

confidence: 99%

Paroxysmal sympathetic hyperexcitability after brain injury: A clinical analysis of case series

Li,

Yang,

et al. 2024

Medicine

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Background: Paroxysmal sympathetic hyperexcitability (PSH) is a group of complex syndromes with various etiologies. Previous studies were limited to the description of traumatic brain injury (TBI), and the description of PSH after other types of brain injury was rare. We explored the clinical features, treatment, and prognosis of PSH after various types of brain injuries. Methods: Patients admitted to the neurosurgery intensive care unit with PSH after brain injury from July 2019 to December 2022 were included. Demographic data, clinical manifestations, drug therapy, and disease prognosis were retrospectively collected and analyzed. Results: Fifteen male and 9 female patients with PSH after brain injury were selected. TBI was most likely to cause PSH (66.7%), followed by spontaneous intracerebral hemorrhage (25%). Glasgow coma scale scores of 19 patients (79.2%) were lower than 8 and 14 patients (58.3%) underwent tracheotomy. Electroencephalogram monitoring was performed in 12 individuals, none of which showed epileptic waves. Clinical symptom scale showed mild symptoms in 17 cases (70.8%). Almost all patients were administered a combination of drugs. After follow-up, most patients had a poor prognosis and 2 (8.3%) died after discharge. Conclusion: The etiology of PSH is complex. TBI may be the most common cause of PSH. Non-TBI may also be an important cause of PSH. Therefore, early identification, prevention and diagnosis are helpful for determining the prognosis and outcome of the disease.

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Risk factors and clinical features of paroxysmal sympathetic hyperactivity after spontaneous intracerebral hemorrhage

Cited by 7 publications

References 30 publications

Characteristics and Outcomes of Autonomic Dysfunction in Anti-NMDAR Encephalitis

Characteristics and Outcomes of Autonomic Dysfunction in Anti-NMDAR Encephalitis

Characteristics and Outcomes of Paroxysmal Sympathetic Hyperactivity in Anti-NMDAR Encephalitis

Paroxysmal sympathetic hyperexcitability after brain injury: A clinical analysis of case series

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