Skip to main content
Erschienen in: Current Neurology and Neuroscience Reports 11/2014

01.11.2014 | Neurotrauma (J Levine, Section Editor)

Paroxysmal Sympathetic Hyperactivity after Severe Brain Injury

verfasst von: Devon Lump, Megan Moyer

Erschienen in: Current Neurology and Neuroscience Reports | Ausgabe 11/2014

Einloggen, um Zugang zu erhalten

Abstract

Paroxysmal sympathetic hyperactivity (PSH) is characterized by the rapid onset and paroxysmal cycling of agitation and dystonia in association with autonomic symptoms. These symptoms may include the following: tachycardia, hypertension, tachypnea, fever, pupil dilation, decreased level of consciousness, diaphoresis, and ventilator dyssynchrony. In a critically ill patient, these are all nonspecific symptoms that may reflect impending sepsis, seizure, or a number of other complications. This can confound and delay the diagnosis and treatment of PSH. While this phenomenon has been frequently observed in the traumatic brain injured population, management is highly variable, prompting this review of the literature. This article aims to outline the evidence base for the management of PSH, as well as to describe an algorithm for management developed at our institution.
Literatur
1.
Zurück zum Zitat Penfield W. Diencephalic autonomic epilepsy. Arch Neurol Psychiatry. 1929;22:358–74.CrossRef Penfield W. Diencephalic autonomic epilepsy. Arch Neurol Psychiatry. 1929;22:358–74.CrossRef
2.
Zurück zum Zitat Baguley IJ. Autonomic complications following central nervous system injury. Sem Neurol. 2008;28(5):716–25.CrossRef Baguley IJ. Autonomic complications following central nervous system injury. Sem Neurol. 2008;28(5):716–25.CrossRef
3.
Zurück zum Zitat Perkes I, Baguley IJ, Nott MT, et al. A review of paroxysmal sympathetic hyperactivity after acquired brain injury. Ann Neurol. 2010;68(2):126–35.PubMedCrossRef Perkes I, Baguley IJ, Nott MT, et al. A review of paroxysmal sympathetic hyperactivity after acquired brain injury. Ann Neurol. 2010;68(2):126–35.PubMedCrossRef
4.
Zurück zum Zitat Rabinstein AA. Paroxysmal sympathetic hyperactivity in the neurological intensive care unit. Neurol Res. 2007;29(7):680–2.PubMedCrossRef Rabinstein AA. Paroxysmal sympathetic hyperactivity in the neurological intensive care unit. Neurol Res. 2007;29(7):680–2.PubMedCrossRef
5.
Zurück zum Zitat Baguley IJ, Nott MT, Slewa-Younan S, et al. Diagnosing dysautonomia after acute traumatic brain injury: evidence for over-responsiveness to afferent stimuli. Arch Phys Med Rehabil. 2009;90:580–6.PubMedCrossRef Baguley IJ, Nott MT, Slewa-Younan S, et al. Diagnosing dysautonomia after acute traumatic brain injury: evidence for over-responsiveness to afferent stimuli. Arch Phys Med Rehabil. 2009;90:580–6.PubMedCrossRef
6.
Zurück zum Zitat Baguley IJ, Heriseanu RE, Cameron ID, et al. A critical review of the pathophysiology of dysautonomia following traumatic brain injury. Neurocrit Care. 2008;8:293–300.PubMedCrossRef Baguley IJ, Heriseanu RE, Cameron ID, et al. A critical review of the pathophysiology of dysautonomia following traumatic brain injury. Neurocrit Care. 2008;8:293–300.PubMedCrossRef
7.
Zurück zum Zitat Lemke DM. Sympathetic storming after severe traumatic brain injury. Crit Care Nurse. 2007;27(1):30–7.PubMed Lemke DM. Sympathetic storming after severe traumatic brain injury. Crit Care Nurse. 2007;27(1):30–7.PubMed
8.
Zurück zum Zitat Blackman JA, Patrick PD, Buck ML, et al. Paroxysmal autonomic instability with dystonia after brain injury. Arch Neurol. 2004;61:321–8.PubMedCrossRef Blackman JA, Patrick PD, Buck ML, et al. Paroxysmal autonomic instability with dystonia after brain injury. Arch Neurol. 2004;61:321–8.PubMedCrossRef
9.
Zurück zum Zitat Rabinstein AA, Benarroch EE. Treatment of paroxysmal sympathetic hyperactivity. Curr Treat Options Neurol. 2008;10(2):151–7.PubMedCrossRef Rabinstein AA, Benarroch EE. Treatment of paroxysmal sympathetic hyperactivity. Curr Treat Options Neurol. 2008;10(2):151–7.PubMedCrossRef
10.
Zurück zum Zitat Perkes IE, Menon DK, Nott MT, et al. Paroxysmal sympathetic hyperactivity after acquired brain injury: a review of diagnostic criteria. Brain Inj. 2011;25(10):925–32.PubMedCrossRef Perkes IE, Menon DK, Nott MT, et al. Paroxysmal sympathetic hyperactivity after acquired brain injury: a review of diagnostic criteria. Brain Inj. 2011;25(10):925–32.PubMedCrossRef
11.•
Zurück zum Zitat Hughes JD, Rabinstein AA. Early diagnosis of paroxysmal hyperactivity in the ICU. Neurocrit Care. 2013. Hughes et al. retrospectively reviewed electronic medical records of critically ill patients with acquired brain injury from 2006–2012 who demonstrated PSH. Fifty-three patients were identified as having PSH. Individual patient records were evaluated to ascertain which PSH symptoms were noted to support the diagnosis. Eighty-nine percent of patients who were clinically diagnosed with PSH also met the formal diagnostic criteria, thus, validating PSH can be accurately diagnosed in the ICU and strict diagnostic criteria generally supports the clinician’s insight. Hughes JD, Rabinstein AA. Early diagnosis of paroxysmal hyperactivity in the ICU. Neurocrit Care. 2013. Hughes et al. retrospectively reviewed electronic medical records of critically ill patients with acquired brain injury from 2006–2012 who demonstrated PSH. Fifty-three patients were identified as having PSH. Individual patient records were evaluated to ascertain which PSH symptoms were noted to support the diagnosis. Eighty-nine percent of patients who were clinically diagnosed with PSH also met the formal diagnostic criteria, thus, validating PSH can be accurately diagnosed in the ICU and strict diagnostic criteria generally supports the clinician’s insight.
12.
Zurück zum Zitat Baguley IJ, Cameron ID, Green AM, et al. Pharmacological management of dysautonomia following traumatic brain injury. Brain Inj. 2004;18(5):409–15.PubMedCrossRef Baguley IJ, Cameron ID, Green AM, et al. Pharmacological management of dysautonomia following traumatic brain injury. Brain Inj. 2004;18(5):409–15.PubMedCrossRef
13.
Zurück zum Zitat Baguley IJ, Slewa-Younan S, Heriseanu RE, et al. The incidence of dysautonomia and its relationship with autonomic arousal following traumatic brain injury. Brain Inj. 2007;21(11):1175–81.PubMedCrossRef Baguley IJ, Slewa-Younan S, Heriseanu RE, et al. The incidence of dysautonomia and its relationship with autonomic arousal following traumatic brain injury. Brain Inj. 2007;21(11):1175–81.PubMedCrossRef
14.•
Zurück zum Zitat Fernandez-Ortega JF, Prieto-Palomina MA, Garcia-Caballero M, Galeas-Lopez J, Quesada-Garcia G, Baguley IJ. Paroxysmal sympathetic hyperactivity after traumatic brain injury: clinical and prognostic implications. J Neurotrauma. 2012;29:1364–70. Fernandez-Ortega et al. published a prospective study, in which they evaluated all ICU severe TBI admissions over an 18-month period of time, identifying 10.1% who experienced PSH. It was noted that the PSH study group had a greater length of ICU stay, higher prevalence of infections, more time spent on mechanical ventilation, higher incidence of tracheostomy placement, and longer course of hospitalization.PubMedCrossRef Fernandez-Ortega JF, Prieto-Palomina MA, Garcia-Caballero M, Galeas-Lopez J, Quesada-Garcia G, Baguley IJ. Paroxysmal sympathetic hyperactivity after traumatic brain injury: clinical and prognostic implications. J Neurotrauma. 2012;29:1364–70. Fernandez-Ortega et al. published a prospective study, in which they evaluated all ICU severe TBI admissions over an 18-month period of time, identifying 10.1% who experienced PSH. It was noted that the PSH study group had a greater length of ICU stay, higher prevalence of infections, more time spent on mechanical ventilation, higher incidence of tracheostomy placement, and longer course of hospitalization.PubMedCrossRef
15.•
Zurück zum Zitat Laxe S, Terre R, Leon D, Bernaneu M. How does dysautonomia influence the outcome of traumatic brain injured patients admitted in a neurorehabilitation unit? Brain Inj. 2013;27(12):1383–7. Laxe et al. performed a prospective study analyzing the records of patients admitted to neurorehabilitation for TBI over a three year period of time. At the time of rehab PSH did not seem to affect the recovery during rehab and functional status at discharge from rehab, however, patients in the PSH group were more likely to require psychoactive medications. The overall level of improvement was greater in the non-PSH group.PubMedCrossRef Laxe S, Terre R, Leon D, Bernaneu M. How does dysautonomia influence the outcome of traumatic brain injured patients admitted in a neurorehabilitation unit? Brain Inj. 2013;27(12):1383–7. Laxe et al. performed a prospective study analyzing the records of patients admitted to neurorehabilitation for TBI over a three year period of time. At the time of rehab PSH did not seem to affect the recovery during rehab and functional status at discharge from rehab, however, patients in the PSH group were more likely to require psychoactive medications. The overall level of improvement was greater in the non-PSH group.PubMedCrossRef
16.
Zurück zum Zitat Baguley IJ, Heriseanu RE, Gurka JA, et al. Gabapentin in the management of dysautonomia following severe traumatic brain injury: a case series. J Neurol Neurosurg Psychiatry. 2007;78(5):539–41.PubMedCrossRefPubMedCentral Baguley IJ, Heriseanu RE, Gurka JA, et al. Gabapentin in the management of dysautonomia following severe traumatic brain injury: a case series. J Neurol Neurosurg Psychiatry. 2007;78(5):539–41.PubMedCrossRefPubMedCentral
17.
Zurück zum Zitat Sills GJ. The mechanisms of action of gabapentin and pregabalin. Curr Opin Pharmacol. 2006;6(1):108–13.PubMedCrossRef Sills GJ. The mechanisms of action of gabapentin and pregabalin. Curr Opin Pharmacol. 2006;6(1):108–13.PubMedCrossRef
18.
19.
Zurück zum Zitat Goddeau RP, Silverman SB, Sims JR. Dexmedetomidine for the treatment of paroxysmal autonomic instability with dystonia. Neurocrit Care. 2007;7:217–20.PubMedCrossRef Goddeau RP, Silverman SB, Sims JR. Dexmedetomidine for the treatment of paroxysmal autonomic instability with dystonia. Neurocrit Care. 2007;7:217–20.PubMedCrossRef
20.
Zurück zum Zitat Hoarau X, Richer E, Dehail P, Cuny E. A 10-year follow-up study of patients with severe traumatic brain injury and dysautonomia treated with intrathecal baclofen therapy. Brain Inj. 2012;26(7–8):927–40.PubMedCrossRef Hoarau X, Richer E, Dehail P, Cuny E. A 10-year follow-up study of patients with severe traumatic brain injury and dysautonomia treated with intrathecal baclofen therapy. Brain Inj. 2012;26(7–8):927–40.PubMedCrossRef
Metadaten
Titel
Paroxysmal Sympathetic Hyperactivity after Severe Brain Injury
verfasst von
Devon Lump
Megan Moyer
Publikationsdatum
01.11.2014
Verlag
Springer US
Erschienen in
Current Neurology and Neuroscience Reports / Ausgabe 11/2014
Print ISSN: 1528-4042
Elektronische ISSN: 1534-6293
DOI
https://doi.org/10.1007/s11910-014-0494-0

Weitere Artikel der Ausgabe 11/2014

Current Neurology and Neuroscience Reports 11/2014 Zur Ausgabe

Neuroimaging (DJ Brooks, Section Editor)

Tau PET Imaging in Alzheimer’s Disease

Neurology of Systemic Disease (J Biller, Section Editor)

Cerebral Thrombosis and Myeloproliferative Neoplasms

Critical Care (SA Mayer, Section Editor)

Strategies for Streamlining Emergency Stroke Care

Leitlinien kompakt für die Neurologie

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Akuter Schwindel: Wann lohnt sich eine MRT?

28.04.2024 Schwindel Nachrichten

Akuter Schwindel stellt oft eine diagnostische Herausforderung dar. Wie nützlich dabei eine MRT ist, hat eine Studie aus Finnland untersucht. Immerhin einer von sechs Patienten wurde mit akutem ischämischem Schlaganfall diagnostiziert.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Frühe Alzheimertherapie lohnt sich

25.04.2024 AAN-Jahrestagung 2024 Nachrichten

Ist die Tau-Last noch gering, scheint der Vorteil von Lecanemab besonders groß zu sein. Und beginnen Erkrankte verzögert mit der Behandlung, erreichen sie nicht mehr die kognitive Leistung wie bei einem früheren Start. Darauf deuten neue Analysen der Phase-3-Studie Clarity AD.

Viel Bewegung in der Parkinsonforschung

25.04.2024 Parkinson-Krankheit Nachrichten

Neue arznei- und zellbasierte Ansätze, Frühdiagnose mit Bewegungssensoren, Rückenmarkstimulation gegen Gehblockaden – in der Parkinsonforschung tut sich einiges. Auf dem Deutschen Parkinsonkongress ging es auch viel um technische Innovationen.

Update Neurologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.