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Paroxysmal Sympathetic Hyperactivity and Clinical Considerations for Patients With Acquired Brain Injuries

A Narrative Review

Thomas, Alphonsa, DO; Greenwald, Brian D., MD

American Journal of Physical Medicine & Rehabilitation: January 2019 - Volume 98 - Issue 1 - p 65–72
doi: 10.1097/PHM.0000000000000990
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The term “storming” has often been used colloquially to characterize patients with brain injury who showed signs and symptoms of elevated heart rate, blood pressure, respiratory rate, temperature, and motor posturing. Recently, the term paroxysmal sympathetic hyperactivity 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 paroxysmal sympathetic hyperactivity are limited but point toward poorer functional outcome and increased mortality. Overall, the phenomenon of paroxysmal sympathetic hyperactivity 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 paroxysmal sympathetic hyperactivity.

From the JFK Medical Center-Johnson Rehabilitation Institute, Edison, New Jersey.

All correspondence should be addressed to: Brian D. Greenwald, MD, Center for Brain Injuries, JFK Medical Center-Johnson Rehabilitation Institute, 65 James St, Edison, NJ 08820.

Alphonsa Thomas is in training.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.