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Published on: May 27, 2022
Paroxysmal sympathetic hyperactivity in pediatric traumatic brain injury: A case series of four patients
Akhil Deepika1, Manish Joseph Mathew2, S Arun Kumar2
1Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 560029, India.
Insights
Paroxysmal sympathetic hyperactivity (PSH) is a serious condition following pediatric traumatic brain injury (TBI). This study highlights its occurrence and links PSH to poorer outcomes in children with severe head injuries.
Area of Science:
- Neuroscience
- Pediatric Critical Care
- Autonomic Dysfunction
Background:
- Paroxysmal sympathetic hyperactivity (PSH) involves extreme autonomic dysregulation with recurrent sympathetic overactivity.
- PSH occurrence in pediatric traumatic brain injury (TBI) is underrecognized.
- Understanding PSH incidence and impact in pediatric TBI is crucial.
Observation:
- A series of pediatric patients with moderate to severe head injuries were monitored for PSH.
- Four out of 36 pediatric severe TBI cases exhibited PSH features.
- Patients with PSH had low initial Glasgow Coma Scale (GCS) scores and prolonged ICU stays.
Findings:
- PSH in pediatric TBI is associated with significant morbidity.
- Observed outcomes included increased mortality, prolonged recovery, and higher infection rates.
- The study observed poor discharge scores (DRS) in affected children.
Implications:
- The findings underscore the need for increased awareness of PSH in pediatric TBI.
- Current management guidelines for PSH require refinement and standardization.
- Further research is needed to determine the exact incidence and optimal treatment strategies for PSH in pediatric populations.
Abstract:
Paroxysmal sympathetic hyperactivity (PSH) is a condition in which there is extreme autonomic dysregulation leading to multiple episodes of sympathetic hyperactivity. Its occurrence after traumatic brain injury (TBI) in pediatric population is a neglected scenario. In our series, all pediatric patients with moderate and severe head injuries were studied and those patients who developed PSH were monitored for the PSH episodes. Four children out of 36 cases of pediatric severe traumatic brain injury developed features of PSH. Admission GCS of 3 children were 4/15 and 1 child was 6/15 and each of them had an ICU stay of more than 2 weeks and a poor DRS score at discharge. The presence of PSH is known to produce poorer outcome in terms of overall mortality, time needed for recovery, chances of developing infections, etc. which was also seen in these cases presented here. Though some studies have provided guidelines for the management of PSH like symptomatic management and use of drugs like clonidine, bromocriptine, benzodiazepines, and gabapentin, strict management guidelines are not established and exact incidence in pediatric population is not determined.
