Paroxysmal Sympathetic Hyperactivity and Clinical Considerations for Patients with Acquired Brain Injuries: A Narrative Review

The term "storming" has often been used colloquially to characterize brain injured patients who showed signs and symptoms of elevated heart rate, blood pressure, respiratory rate, temperature, and motor posturing. Recently, the term paroxysmal sympathetic hyperactivity (PSH) has been used as the unifying term to describe these acute episodes of elevated sympathetic hyperactivity. Various pharmaceutical and management options are available, but no single drug or protocol has been deemed superior to the others. Data on prognosis and recovery in relation to PSH are limited, but point toward poorer functional outcome and increased mortality. Overall, the phenomenon of PSH requires further research to aid rehabilitative efforts so that patients can effectively participate in therapy. A review of the literature has revealed sparse information on the management of sympathetic storming within rehabilitation facilities. This narrative review seeks to provide an up-to-date synopsis and recommendations on the management of rehabilitation inpatients with PSH. Please address all correspondence to: Brian D. Greenwald, MD, Medical Director of Center for Brain Injuries, JFK Medical Center- Johnson Rehabilitation Institute, 65 James Street, Edison, NJ, 08820. Phone: 732-321-7000 ext: 62018. Fax: 732-321-7733. Email: BGreenwald@hackensackmeridian.org There are no disclosures or conflicts of interest reported by the authors. No funding was received by the authors for this work. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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