Paroxysmal Sympathetic Hyperactivity in Acquired Brain Injury: A Case Series

Background and Aim: Paroxysmal sympathetic hyperactivity (PSH) is a clinical syndrome characterized by paroxysmal and transient episodes of fever, tachypnea, tachycardia, hypertension, diaphoresis, and dystonia following non-noxious stimuli. It is a rare clinical condition and is seen in patients with acquired brain injury (trauma, meningitis, encephalitis, and stroke). Paroxysmal sympathetic hyperactivity-assessment measure (PSH-AM) is a clinical tool for diagnosing PSH. This study aims to describe the clinical characteristics and the outcomes of PSH. Case Presentation: Of the 412 patients admitted to the neurosurgery intensive care unit at PSGIMSR, Coimbatore, India, 11 (2.6%) patients were diagnosed to have PSH according to the PSH-AM scale. Trauma (72%) was the leading cause of the development of PSH. All patients (100%) had developed at least two PSH episodes per day that persisted for at least 3 consecutive days. Tachycardia and tachypnea were the most common symptoms noted in all PSH patients. The Glasgow Outcome Score (GOS) was less than 3 in 72% of PSH cases at the time of discharge, indicating a poor outcome. Conclusion: Traumatic brain injury remained the leading cause of PSH. The duration of hospitalization was increased in patients with PSH. Along with the prompt treatment of the primary disease, appropriate medications to overcome sympathetic hyperactivity ensure better recovery for these patients. Patients with PSH had relatively poor GOS at the time of discharge.