Paroxysmal Sympathetic Hyperactivity after Severe Brain Injury

  title={Paroxysmal Sympathetic Hyperactivity after Severe Brain Injury},
  author={Devon Lump and Megan T. Moyer},
  journal={Current Neurology and Neuroscience Reports},
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… 
Paroxysmal Sympathetic Hyperactivity.
Paroxysmal sympathetic hyperactivity (PSH) is a relatively common, but often unrecognized, complication of acute diffuse or multifocal brain diseases, most frequently encountered in young comatose
Treatment Progress of Paroxysmal Sympathetic Hyperactivity after Acquired Brain Injury
The purpose of this review is to determine the treatment strategies and drugs commonly used for PSH at the overall level.
Identification and Management of Paroxysmal Sympathetic Hyperactivity After Traumatic Brain Injury
The purpose of this review is to present current and comprehensive studies of the identification of PSH after TBI in the early stage and provide a framework for symptomatic management of TBI patients with PSH.
Paroxysmal Sympathetic Hyperactivity: Diagnostic Criteria, Complications, and Treatment after Traumatic Brain Injury
Much further investigation is needed to systematically assess the multiple currently utilized treatment modalities, and their effect on long-term outcomes based on the current defining criteria.
Paroxysmal sympathetic hyperactivity: An entity to keep in mind.
Unresponsive hypertension in a child with meningoencephalitis due to paroxysmal sympathetic hyperactivity
This work describes a child managed in a general paediatric ward as for probable tuberculous meningitis complicated with PSH, a condition not common in children.
Paroxysmal sympathetic hyperactivity: Autonomic instability and muscle over-activity following severe brain injury
A literature review regarding PSH following severe brain injury and highlight research needs in children with PSH is presented, finding several themes emerged regarding the phenomenon of interest: nomenclature, symptoms, management and differences between children and adults.
Paroxysmal sympathetic hyperactivity syndrome caused by fat embolism syndrome
Two cases of paroxysmal sympathetic hyperactivity after cerebral fat embolism are reported, which is a very uncommon association.
Paroxysmal Sympathetic Hyperactivity and Clinical Considerations for Patients With Acquired Brain Injuries: A Narrative Review
The phenomenon of paroxysmal sympathetic hyperactivity requires further research to aid rehabilitative efforts so that patients can effectively participate in therapy.


Paroxysmal autonomic instability with dystonia after brain injury.
Paroxysmal autonomic instability with dystonia appears to be a distinctive syndrome after brain injury that can mimic other life-threatening conditions and may lead to fewer diagnostic tests and a rational approach to management.
Treatment of paroxysmal sympathetic hyperactivity
Early recognition and adequate treatment of paroxysmal sympathetic hyperactivity is important to avoid prolongation of the patient’s stay in the intensive care unit and to enable recovering patients to participate without restrictions in rehabilitation therapy.
Dexmedetomidine for the treatment of paroxysmal autonomic instability with dystonia
Dexmedetomidine may be a novel pharmacologic agent to aid in abrogating PAID.
A review of paroxysmal sympathetic hyperactivity after acquired brain injury
This systematic literature review identified 2 separate categories of paroxysmal autonomic overactivity, 1 characterized by relatively pure sympathetic overactivity and another group of disorders with mixed parasympathetic/sympathetic features.
Gabapentin in the management of dysautonomia following severe traumatic brain injury: a case series
It is proposed that medications that can block or minimise abnormal afferent stimuli may represent a better option for dysautonomia management than drugs which increase inhibition of efferent pathways.
Autonomic complications following central nervous system injury.
The evidence base for autonomic dysreflexia following spinal cord injury is much stronger, with level 1 evidence for many treatment interventions, and the main focus is on the literature for dysautonomia.
Paroxysmal sympathetic hyperactivity after acquired brain injury: A review of diagnostic criteria
These findings demarcate the need for a single set of PSH diagnostic criteria and provide the substrate for scientific consensus, as well as comparatively analyse published criteria.
The incidence of dysautonomia and its relationship with autonomic arousal following traumatic brain injury
The 8% incidence of Dysautonomia during ICU admission was in broad agreement with previous research, and a coordinated multi-centre research effort into this condition appears appropriate.
A Critical Review of the Pathophysiology of Dysautonomia Following Traumatic Brain Injury
A critical review of the competing theories against the available observational, clinical and neurotransmitter evidence suggests the EIR Model provides an explanatory model that encompasses other acute autonomic emergency syndromes, accommodates ‘triggering’ of paroxysms and provides a rationale for all known medication effects.
How does dysautonomia influence the outcome of traumatic brain injured patients admitted in a neurorehabilitation unit?
Functional status is similar and PSH does not appear to influence recovery during the rehabilitation, although PSH patients are more likely to undergo psychoactive medications and special care is needed to approach their caregivers that perceive PSH as a complication for rehabilitation.