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Paroxysmal sympathetic hyperactivity after acute brain injury.
H Alex Choi1, Sang-Beom Jeon, Sophie Samuel
1Departments of Neurology and Neurosurgery, The University of Texas Medical School at Houston, 6431 Fannin St., MSB 7.154A, Houston, TX 77030, USA. huimahn.a.choi@uth.tmc.edu
Current Neurology and Neuroscience Reports
|June 20, 2013
Summary
Paroxysmal sympathetic hyperactivity (PSH) is a serious syndrome following brain injury. Effective management requires a balanced approach to control episodes without causing oversedation.
Area of Science:
- Neuroscience
- Critical Care Medicine
- Neurology
Background:
- Paroxysmal sympathetic hyperactivity (PSH) is a syndrome linked to brain injuries like trauma, stroke, and encephalitis.
- It presents with episodes of sympathetic surges, leading to hyperthermia, diaphoresis, tachycardia, hypertension, tachypnea, and dystonic posturing.
- Patients with PSH experience poorer neurological outcomes, extended hospital stays, and increased complications.
Purpose of the Study:
- To highlight the lack of consensus on diagnostic criteria, risk factors, pathophysiology, and treatment for PSH.
- To emphasize the recent focus on establishing diagnostic criteria and proposing new pathophysiological theories.
- To review available treatment options and the limited systemic studies on treatment algorithm efficacy.
Main Methods:
- Review of existing literature on paroxysmal sympathetic hyperactivity.
- Analysis of proposed diagnostic criteria and pathophysiological theories.
- Evaluation of current treatment strategies and their efficacy.
Main Results:
- Consensus on diagnostic criteria, risk factors, and pathophysiology for PSH remains limited.
- New theories regarding PSH pathophysiology have been recently proposed.
- Various medications can be used in combination for regular management, with as-needed medications for acute episodes.
Conclusions:
- Effective PSH management requires a balanced approach, combining scheduled and as-needed medications.
- The goal is to control symptoms and reduce episode frequency/intensity without causing oversedation.
- Further systemic studies are needed to validate treatment algorithms for PSH.
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