Paroxysmal Sympathetic Hyperactivity: An Old but Unrecognized Condition

Patients who survive a traumatic brain injury (TBI) can sometimes experience symptoms of excessive sympathetic discharge. Despite being known about for more than 60 years, the diagnostic criteria for this condition have only recently been defined under the name “paroxysmal sympathetic hyperactivity”. Failure to recognize this syndrome leads to excessive costs, prolonged hospital stays and delayed recovery for TBI patients. This case report describes a patient whose specific rehabilitation program was affected by a failure to identify this entity, even though he presented with many of the characteristics of this condition. LEARNING POINTS: Fever is a common sign in hospitalized patients and can result in expensive investigations and prolong length of stay. It is crucial to consider paroxysmal sympathetic hyperactivity (PSH) as a cause of fever in traumatic brain injury patients (TBI). A delay in diagnosing and treating PSH can have devastating consequences for these patients’ recovery programs.