Traumatic brain injury (TBI) is a complex management condition. Mild to moderate presentation is dealt with mostly in a non-ICU setting, while severe TBI ends up in intensive care units. The presentation and course of severe TBI is a team effort, and attempts are made to prevent complications and reduce morbidity. One condition which is still not clear and usually presents after initial stabilization is sympathetic overactivity. Here we will try to go over unanswered questions about this condition. We do not believe that the suggested answers to these questions are all set in stone and will change as we have a better understanding.
Blackman JA, Patrick PD, Buck ML, et al. Paroxysmal autonomic instability with dystonia after brain injury. Arch Neurol 2004;61(3): 321–328. DOI: 10.1001/archneur.61.3.321
Baguley IJ, Perkes IE, Fenandex-Ortega JF, et al. Paroxysmal sympathetic hyperactivity after acquired brain injury: consensus on conceptual definition, nomenclature, and diagnostic criteria. J Neurotrauma 2014;21(17):1515–1520. DOI: 10.1089/neu.2013.3301
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):1175–1181. DOI: 10.1080/02699050701687375
Hughes JD, Rabinstein AA. Early diagnosis of paroxysmal sympathetic hyperactivity in the ICU. Neurocrit Care 2014;20(3)454–459. DOI: 10.1007/s12028-013-9877-3
Thomas A, Greenwald DB. Paroxysmal sympathetic hyperactivity and clinical considerations for patients with acquired brain injuries. Am J Phys Med Rehabil 2019;98(1):65–72. DOI: 10.1097/PHM.0000000000000990
Baguley IJ. The excitatory: inhibitory ratio model (EIR model): An integrative explanation of acute autonomic overactivity syndromes. Med Hypotheses 2008;70(1):26–35. DOI: 10.1016/j.mehy.2007.04.037
Huang P, Lin WC, Huang Pk, et al. Susceptibility weighted imaging in a patient with paroxysmal sympathetic storms. J Neurol 2009;256(2):276–278. DOI: 10.1007/s00415-009-0957-4
Samuel S, Lee M, Brown RJ, et al. Incidence of paroxysmal sympathetic hyperactivity following traumatic brain injury using assessment tools. Brain Inj 2018;32(9):1115–1121. DOI: 10.1080/02699052.2018.1482002
Li M, Zhu G, Guo H, et al. Cerebral fat embolization with paroxysmal sympathetic hyperactivity syndrome and septic shock at high altitude: a case report and literature review. Chin Neurosurg J 2021;7(1):18. DOI: 10.1186/s41016-021-00232-6
Feyissa AM, Tummala S. Unusual case of paroxysmal sympathetic hyperactivity in a patient with leukemia. Clin Neurophysiol 2014;125(5):1069–1071. DOI: 10.1016/j.clinph.2013.09.023
Holder EK, McCall JC, Feeko JK. Acute disseminated encephalomyelitis in an adult: an uncommon case of paroxysmal sympathetic hyperactivity. PM R 2015;7(7):781–784. DOI: 10.1016/j.pmrj.2015.02.006
Al-Kuraish HM, Al-Gareeb AI, Qusti S, et al. Covid-19-induced dysautonomia: a menace of sympathetic storm. ASN Neuro 2021;13:17590914211057635. DOI:10.1177/17590914211057635
Baguley IJ, Cameron ID, Green AM, et al. Pharmacological management of dysautonomia following traumatic brain injury. Brain Inj 2004;18(5):409–417. DOI: 10.1080/02699050310001645775
Pucks-Faes E, Hitzenberger G, Matzak H, et al. Intrathecal baclofen in paroxysmal sympathetic hyperactivity: impact on oral treatment. Brain Behav 2018;8(11):e01124. DOI: 10.1002/brb3.1124