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Case Reports
. 2022 May 3;14(5):e24693.
doi: 10.7759/cureus.24693. eCollection 2022 May.

Paroxysmal Sympathetic Hyperactivity After Traumatic Brain Injury: What Is Important to Know?

Sidi Mamoun Louraoui  1 , Fadwa Fliyou  1 , Jehanne Aasfara  2 , Abdessamad El Azhari  1
Affiliations
Case Reports

Paroxysmal Sympathetic Hyperactivity After Traumatic Brain Injury: What Is Important to Know?

Sidi Mamoun Louraoui et al. Cureus. .

Abstract

Traumatic brain injury (TBI) is one of the leading causes of morbidity and mortality. The etiologies of TBI are varied and its complications can lead to paroxysmal sympathetic hyperactivity that was first described as a "sympathetic storm" or "diencephalic autonomic seizure." The clinical manifestations are rapid and sudden onset of sympathetic hyperactivity characterized by tachycardia, systolic hypertension, hyperthermia, tachypnea, and diaphoresis, all summarized in the latest and most accepted diagnostic criteria. The pathophysiology remains controversial with many theories proposed. Given the clinical manifestations, the complications, outcomes, and lack of popularity of the syndrome, we report a case treated in our institution and review the current pathophysiology and treatment options.

Keywords: dysautonomia; paroxysmal sympathetic hyperactivity; psh; sympathetic storm; traumatic brain injury.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Preoperative axial non-injected CT scan showing the subdural hematoma, brain edema, and frontal contusions.
A: Red arrow showing the fronto-temporal-occipital subdural hematoma. B: Red arrow showing the frontal contusion and brain edema. CT: computed tomography
Figure 2
Figure 2. PSH pathophysiology showing the summary of the physiology of the sympathetic hyperactivity according to the excitatory/inhibitory ratio model and the impact on the organs.
PSH: paroxysmal sympathetic hyperactivity
See this image and copyright information in PMC

References

    1. Paroxysmal sympathetic hyperactivity during traumatic brain injury. Jafari AA, Shah M, Mirmoeeni S, et al. Clin Neurol Neurosurg. 2022;212:107081. - PubMed
    1. [Post-traumatic dysautonomic crises in intensive care unit: a French national assessment] Bapteste L, Carrillon R, Lieutaud T. Ann Fr Anesth Reanim. 2011;30:755–757. - PubMed
    1. Paroxysmal sympathetic hyperactivity: the storm after acute brain injury. Meyfroidt G, Baguley IJ, Menon DK. Lancet Neurol. 2017;16:721–729. - PubMed
    1. Paroxysmal sympathetic hyperactivity after acquired brain injury: a review of diagnostic criteria. Perkes IE, Menon DK, Nott MT, Baguley IJ. Brain Inj. 2011;25:925–932. - PubMed
    1. Paroxysmal sympathetic hyperactivity after acquired brain injury: consensus on conceptual definition, nomenclature, and diagnostic criteria. Baguley IJ, Perkes IE, Fernandez-Ortega JF, Rabinstein AA, Dolce G, Hendricks HT. J Neurotrauma. 2014;31:1515–1520. - PubMed

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