Paroxysmal Sympathetic Hyperactivity After Acute Brain Injury

Paroxysmal sympathetic hyperactivity is a syndrome associated with brain trauma, stroke, encephalitis, and other forms of brain injury. It is characterized by uncontrolled episodes of unbalanced sympathetic surges causing hyperthermia, diaphoresis, tachycardia, hypertension, tachypnea, and dystonic...

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Bibliographic Details
Published in:Current neurology and neuroscience reports 2013-08, Vol.13 (8), p.370, Article 370
Main Authors: Choi, H. Alex, Jeon, Sang-Beom, Samuel, Sophie, Allison, Teresa, Lee, Kiwon
Format: Article
Language:English
Subjects:
Autonomic Nervous System Diseases - complications
Autonomic Nervous System Diseases - diagnosis
Autonomic Nervous System Diseases - drug therapy
Autonomic Nervous System Diseases - epidemiology
Autonomic Nervous System Diseases - physiopathology
Baclofen
Benzodiazepines
Brain Injuries - complications
Brain Injuries - diagnosis
Brain Injuries - epidemiology
Brain Injuries - physiopathology
Critical Care (SA Mayer
Disease Management
Encephalitis
Gabapentin
Humans
Hyperactivity
Hyperthermia
Medicine & Public Health
Morphine
Neurology
Neurosciences
Pathophysiology
Risk Factors
Section Editor
Tachycardia
Topical Collection on Critical Care
Trauma
Traumatic brain injury
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Summary:Paroxysmal sympathetic hyperactivity is a syndrome associated with brain trauma, stroke, encephalitis, and other forms of brain injury. It is characterized by uncontrolled episodes of unbalanced sympathetic surges causing hyperthermia, diaphoresis, tachycardia, hypertension, tachypnea, and dystonic posturing. Patients who develop paroxysmal sympathetic hyperactivity have worse neurologic outcomes, longer hospital stays, and more complications. Despite the clear negative impact on outcome, consensus regarding diagnostic criteria, risk factors, pathophysiology, and treatment approaches is lacking. Recently, the importance of consensus regarding diagnostic criteria has been emphasized, and new theories of pathophysiology have been proposed. Many treatment options are available, but only a few systemic studies of the efficacy of treatment algorithms exist. Treatments should focus on decreasing the frequency and intensity of episodes with regularly scheduled doses of medications, such as long-acting benzodiazepines, nonselective β-blockers, α 2 -agonists, morphine, baclofen, and gabapentin, usually in combination. Treatment of acute breakthrough episodes should focus on doses of as-needed morphine and short-acting benzodiazepines. A balance between control of symptoms without oversedation is the goal.
ISSN:1528-4042
1534-6293
DOI:10.1007/s11910-013-0370-3