Autonomic Hyperactivity

Alejandro A. Rabinstein, MD, FAAN Autonomic Disorders p. 138-153 February 2020, Vol.26, No.1 doi: 10.1212/CON.0000000000000811
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PURPOSE OF REVIEW Autonomic hyperactivity is a relatively common consequence of severe acute brain injury and can also be seen with spinal cord and peripheral nerve disorders. This article reviews basic pathophysiologic concepts regarding autonomic hyperactivity, its various forms of clinical presentation, and practical management considerations.

RECENT FINDINGS Paroxysmal sympathetic hyperactivity is most common after traumatic brain injury but can also occur after other forms of severe acute diffuse or multifocal brain injury. Formal criteria for the diagnosis and severity grading of paroxysmal sympathetic hyperactivity have now been proposed. A growing body of literature is beginning to elucidate the mechanisms underlying this disorder, but treatment remains based on observational data. Our mechanistic understanding of other distinct forms of autonomic hyperactivity, such as autonomic dysreflexia after traumatic spinal cord injury and dysautonomia after Guillain-Barré syndrome, remains rudimentary, yet clinical experience shows that their appropriate management can minimize the risk of serious complications.

SUMMARY Syndromes of autonomic hyperactivity can result from injury at all levels of the neuraxis. Much more research is needed to refine our understanding of these disorders and guide optimal management decisions.

Address correspondence to Dr Alejandro A. Rabinstein, Mayo Clinic, 200 First St SW, Rochester, MN 55905, rabinstein.alejandro@mayo.edu.

RELATIONSHIP DISCLOSURE: Dr Rabinstein serves as an associate editor of Neurocritical Care and on the editorial board of Continuum and receives publishing royalties from Elsevier and Oxford University Press.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Rabinstein reports no disclosure.

© 2020 American Academy of Neurology.