Paroxysmal sympathetic hyperactivity
Wilder Graves Penfield
First to described PSH
Definition
- dysregulated sympathetic activity, resulting from severe brain injury
AKA: Sympathetic storming, autonomic storming; episodic autonomic instability; paroxysmal autonomic instability with dystonia; diencephalic fits
Pathophysiology
- descending inhibitory pathways from cortical inhibitor areas negative modualte sympathetic activity
- in PSH, these descending inhibitory pathways are damaged
Diagnosis
- CFS + DLT scale
Differential diagnosis
- ICH, seizures, sepsis, and PE
Management
- adequate hydration and caloric demand
- opioid agent & GABA agonist & modulator & beta-blocker & muscle relaxant
> opioid agent: morphine
> benzodiazepines: propofol or other benzos
> modulator: clonidine, dexmedetomidine, or gabapentin
> beta-blocker: propranolol
> muscle relaxant: dantrolene, bromocriptine, baclofen