Rehabilitation of paroxysmal sympathetic hyperactivity secondary to severe brain injury: A case report

Paroxysmal sympathetic hyperactivity (PSH) is a complication of severe brain injury (SBI), characterised by paroxysms of excessive sympathetic nervous system activity, with manifestations such as fever, tachycardia, hypertension, excessive sweating and abnormal high muscle tone. PSH can delay diagnosis and rehabilitation, impacting the functional recovery of patients. The present case report aims to explore rehabilitation management strategies and treatment effects for PSH. The case of a 31-year-old woman who presented with rapid onset of PSH following SBI is included in the report. The patient received comprehensive rehabilitation treatment after transfer to The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, China), 5 months after the initial brain injury. Neurological function recovery, symptom relief and changes in functional outcomes were evaluated. Management focused on autonomic nervous system dysfunction and an individualised rehabilitation programme. Following comprehensive rehabilitation, the PSH symptoms of the patient demonstrated notable improvement. The frequency of PSH episodes decreased from several times per week to once every 1-2 months, and episode duration shortened to <1 min. The PSH-assessment measure total score was 26 at initial diagnosis, 24 at rehabilitation admission and 4 after comprehensive rehabilitation treatment. The Glasgow Coma Scale score improved from E1VTM1 to E4VTM3. Brunnstrom stages of bilateral upper limbs, hands and lower limbs progressed from I-I-I to II-II-II. In conclusion, in the present patient with PSH secondary to SBI, a stepwise, multidisciplinary rehabilitation strategy was temporally associated with symptomatic improvement, recovery of neurological function and improvement in activities of daily living. These findings suggest the potential clinical feasibility of an integrated rehabilitation approach for managing PSH.