Paroxysmal Sympathetic Hyperactivity: Clinical Features, Identification and Treatment | ||||
| Zagazig University Medical Journal | ||||
| Volume 31, Issue 1, January 2025, Page 279-287 PDF (494.32 K) | ||||
| Document Type: Review Articles | ||||
| DOI: 10.21608/zumj.2024.323682.3599 | ||||
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| Authors | ||||
Essamedin M. Negm1; Mohammed El Mowafy Khatab1; Essam Mohamed Elsayed Youssef 2; AnaSimon Alfred Foad Eskandr  3; Heba Mohammed Fathi1
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| 1Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Zagazig University, Egypt | ||||
| 2Department of Neurosurgery, Faculty of Medicine, Zagazig University, Egypt | ||||
| 3Department of Critical Care Medicine, Zagazig Chest Hospital, Zagazig, Egypt | ||||
| Abstract | ||||
| Background: In individuals with severe traumatic brain damage, paroxysmal sympathetic hyperactivity episodes also known as autonomic storms are not unusual. Fever, tachycardia, hypertension, tachypnea, hyperhidrosis, and dystonic posture are some of their distinguishing features. The episodes could start on their own or be brought on by stimuli. Although their pathogenesis is yet unclear, their symptoms unmistakably point to the activation or disinhibition of sympathoexcitatory regions. These spells are frequently mistaken for seizures, which results in needless antiepileptic medication treatment. Adequate hydration, ruling out mimicking illnesses (infection, pulmonary embolism, hydrocephalus, epilepsy), providing efficient analgesics, and avoiding triggers when recognized are general guidelines for managing paroxysmal sympathetic hyperactivity. Pharmacologic medications that are most beneficial are morphine sulfate and nonselective β-blockers, such as propranolol. When treating refractory instances, intrathecal baclofen may be useful. Although their effectiveness is less constant, bromocriptine and clonidine can be beneficial for certain patients. Conclusion: PSH is a quite common, but generally ignored, complication of acute diffuse or multifocal brain diseases. It is most commonly seen in young, unconscious individuals who have suffered a severe traumatic brain injury. Recurrent, abrupt episodes of tachycardia, tachypnea, hypertension, perspiration, and occasionally fever and dystonic posture are the hallmarks of the condition. There is a clinical diagnosis. Reducing any external stimuli that may cause the episodes and initiating preventive and abortion medications (such intravenous morphine, gabapentin, propranolol, and clonidine) are also part of the treatment. Early and sufficient PSH treatment may lower the risk of subsequent issues such muscle contractures, malnourishment, and dehydration. | ||||
| Keywords | ||||
| Paroxysmal sympathetic hyperactivity; Traumatic brain injury; Intensive care unit | ||||
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