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Systems Analysis of the Neuroinflammatory and Hemodynamic Response to Traumatic Brain Injury
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Paroxysmal sympathetic hyperactivity after severe brain injury
1Department of Neurosurgery and Neurocritical Care, Hospital of the University of Pennsylvania, 3rd Floor Silverstein Building, 3400 Spruce St., Philadelphia, PA, 19104, USA, devon.lump@uphs.upenn.edu.
Current Neurology and Neuroscience Reports
|September 16, 2014
Summary
Paroxysmal sympathetic hyperactivity (PSH) presents with sudden agitation and autonomic symptoms, mimicking other critical conditions. This review clarifies PSH management strategies and proposes an institutional algorithm.
Area of Science:
- Neurology
- Critical Care Medicine
- Autonomic Dysfunction
Background:
- Paroxysmal sympathetic hyperactivity (PSH) involves rapid episodes of agitation, dystonia, and autonomic symptoms like tachycardia, hypertension, fever, and diaphoresis.
- These nonspecific symptoms in critically ill patients can be misdiagnosed as sepsis or seizures, delaying PSH treatment.
- PSH is frequently observed in traumatic brain injury patients, but management approaches remain highly variable.
Purpose of the Study:
- To review the existing evidence base for managing paroxysmal sympathetic hyperactivity.
- To present a novel algorithm for PSH management developed at the authors' institution.
Main Methods:
- Literature review of studies pertaining to paroxysmal sympathetic hyperactivity.
- Development and description of a clinical management algorithm for PSH.
Main Results:
- The review synthesizes current understanding of PSH pathophysiology and clinical presentation.
- The proposed algorithm offers a structured approach to diagnosing and managing PSH in critically ill patients.
Conclusions:
- Effective management of PSH requires recognizing its distinct clinical features despite overlapping symptoms with other conditions.
- Standardized management protocols, such as the proposed algorithm, are needed to improve patient outcomes in PSH.
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