The Autonomic Storm

Alejandro Rabinstein, Eleco F.M. Wijdicks

Research output: Chapter in Book/Report/Conference proceedingChapter

1 Citation (Scopus)

Abstract

This chapter focuses on the diagnosis and management of autonomic storm that occurs after a severe brain injury. The diagnosis of autonomic storm is based on the recognition of the regular pattern of dysautonomic spells in a patient with acute intracranial disease. It must be distinguished from other syndromes that have features of autonomic instability-such as neuroleptic malignant syndrome-malignant hyperthermia, and lethal catatonia. Lethal catatonia is most often seen in patients with psychiatric disorders but can also occur after viral encephalitis. Morphine sulfate, bromocriptine, and nonselective β-blockers-such as labetalol or propranolol-have been successfully used to treat autonomic storms. These agents may be used alone or in combination, especially during the acute phase. Once dysautonomic manifestations have been under control for several weeks, the medications may be tapered while carefully watching for symptom recurrence. Often, it is necessary to continue treatment for several months. The mechanisms by which opioids, dopamine (DA) agonists, and β-blockers improve dysautonomia remain speculative. Antiepileptic drugs are typically not helpful in true cases of autonomic storm but should be tried if questions about a possible epileptic nature of the spells persist. Systematic studies of different treatment regimens are needed to optimize outcome in patients with autonomic storm.

Original languageEnglish (US)
Title of host publicationPrimer on the Autonomic Nervous System
Subtitle of host publicationSecond Edition
PublisherElsevier Inc.
Pages257-259
Number of pages3
ISBN (Electronic)9780080473963
ISBN (Print)9780125897624
DOIs
StatePublished - May 5 2004

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Catatonia
Primary Dysautonomias
Viral Encephalitis
Neuroleptic Malignant Syndrome
Labetalol
Malignant Hyperthermia
Bromocriptine
Dopamine Antagonists
Dopamine Agonists
Acute Disease
Propranolol
Anticonvulsants
Brain Injuries
Morphine
Opioid Analgesics
Psychiatry
Recurrence
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)
  • Neuroscience(all)

Cite this

Rabinstein, A., & Wijdicks, E. F. M. (2004). The Autonomic Storm. In Primer on the Autonomic Nervous System: Second Edition (pp. 257-259). Elsevier Inc.. https://doi.org/10.1016/B978-012589762-4/50069-4

The Autonomic Storm. / Rabinstein, Alejandro; Wijdicks, Eleco F.M.

Primer on the Autonomic Nervous System: Second Edition. Elsevier Inc., 2004. p. 257-259.

Research output: Chapter in Book/Report/Conference proceedingChapter

Rabinstein, A & Wijdicks, EFM 2004, The Autonomic Storm. in Primer on the Autonomic Nervous System: Second Edition. Elsevier Inc., pp. 257-259. https://doi.org/10.1016/B978-012589762-4/50069-4
Rabinstein A, Wijdicks EFM. The Autonomic Storm. In Primer on the Autonomic Nervous System: Second Edition. Elsevier Inc. 2004. p. 257-259 https://doi.org/10.1016/B978-012589762-4/50069-4
Rabinstein, Alejandro ; Wijdicks, Eleco F.M. / The Autonomic Storm. Primer on the Autonomic Nervous System: Second Edition. Elsevier Inc., 2004. pp. 257-259
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