Panamerican Journal of Trauma, Critical Care & Emergency Surgery

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VOLUME 11 , ISSUE 1 ( January-April, 2022 ) > List of Articles

Perspectives

Paroxysmal Sympathetic Hyperactivity in TBI: Unanswered Questions

Tariq M Janjua

Citation Information : Janjua TM. Paroxysmal Sympathetic Hyperactivity in TBI: Unanswered Questions. Panam J Trauma Crit Care Emerg Surg 2022; 11 (1):63-65.

DOI: 10.5005/jp-journals-10030-1374

License: CC BY-NC 4.0

Published Online: 24-05-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

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.


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  1. 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
  2. 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
  3. 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
  4. 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
  5. 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
  6. 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
  7. 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
  8. 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
  9. 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
  10. 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
  11. 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
  12. 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
  13. 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
  14. 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
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