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[Paroxysmal sympathetic storm after diffuse axonal head injury].

Pablo Young1, Bárbara C Finn, Débora Pellegrini

  • 1Servicio de Clínica Médica, Hospital Británico de Buenos Aires, Argentina.

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Paroxysmal sympathetic storms are episodic autonomic nervous system alterations following head injuries. Prompt diagnosis and treatment with beta-blockers and morphine are crucial for managing these storms.

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Area of Science:

  • Neuroscience
  • Critical Care Medicine
  • Autonomic Neurology

Background:

  • Paroxysmal sympathetic storms (PSS) are characterized by autonomic dysregulation, including temperature, blood pressure, heart rate, and consciousness changes, often seen after severe traumatic brain injury.
  • These storms manifest with hyperhidrosis, excessive salivation, and extensor posturing, posing diagnostic challenges.

Observation:

  • Two young patients with diffuse axonal head injury developed recurrent episodes of hypertension, tachycardia, and fever.
  • These episodes occurred without epileptiform activity or identifiable infectious causes, suggesting a distinct clinical entity.

Findings:

  • The patients' symptoms, consistent with paroxysmal sympathetic storms, showed excellent response to treatment with beta-blockers and morphine.
  • This highlights the efficacy of specific pharmacological interventions in managing PSS.

Implications:

  • Accurate diagnosis of paroxysmal sympathetic storms is essential to avoid unnecessary investigations like EEGs or infectious workups.
  • Timely diagnosis and targeted treatment can improve patient outcomes and resource allocation in neurocritical care settings.