TY - JOUR
T1 - Paroxysmal Sympathetic Hyperactivity
AU - Scott, Rachael A.
AU - Rabinstein, Alejandro A.
N1 - Publisher Copyright:
© 2020 Thieme Medical Publishers, Inc.. All rights reserved.
PY - 2020/10/1
Y1 - 2020/10/1
N2 - 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 patients with severe traumatic brain injury. It is presumed to be caused by loss of cortical inhibitory modulation of diencephalic and brain stem centers and possible additional maladaptive changes in the spinal cord that combine to produce exaggerated sympathetic responses to stimulation. The syndrome consists of repeated sudden episodes of tachycardia, tachypnea, hypertension, sweating, and sometimes fever and dystonic posturing. The diagnosis is clinical. Treatment includes reducing any external stimulation that can trigger the episodes, and starting abortive (e.g., intravenous morphine) and preventive medications (e.g., gabapentin, propranolol, clonidine). Prompt and adequate treatment of PSH may reduce the likelihood of secondary complications, such as dehydration, weight loss and malnutrition, and muscle contractures.
AB - 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 patients with severe traumatic brain injury. It is presumed to be caused by loss of cortical inhibitory modulation of diencephalic and brain stem centers and possible additional maladaptive changes in the spinal cord that combine to produce exaggerated sympathetic responses to stimulation. The syndrome consists of repeated sudden episodes of tachycardia, tachypnea, hypertension, sweating, and sometimes fever and dystonic posturing. The diagnosis is clinical. Treatment includes reducing any external stimulation that can trigger the episodes, and starting abortive (e.g., intravenous morphine) and preventive medications (e.g., gabapentin, propranolol, clonidine). Prompt and adequate treatment of PSH may reduce the likelihood of secondary complications, such as dehydration, weight loss and malnutrition, and muscle contractures.
KW - autonomic storms
KW - dysautonomia
KW - hypertension
KW - paroxysmal sympathetic hyperactivity
KW - tachycardia
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U2 - 10.1055/s-0040-1713845
DO - 10.1055/s-0040-1713845
M3 - Article
C2 - 32906174
AN - SCOPUS:85091204160
SN - 0271-8235
VL - 40
SP - 485
EP - 491
JO - Seminars in Neurology
JF - Seminars in Neurology
IS - 5
ER -