Paroxysmal Sympathetic Hyperactivity After Traumatic Brain Injury: What Is Important to Know?

Traumatic brain injury (TBI) is one of the leading causes of morbidity and mortality. The etiologies of TBI are varied and its complications can lead to paroxysmal sympathetic hyperactivity that was first described as a “sympathetic storm” or “diencephalic autonomic seizure.” The clinical manifestations are rapid and sudden onset of sympathetic hyperactivity characterized by tachycardia, systolic hypertension, hyperthermia, tachypnea, and diaphoresis, all summarized in the latest and most accepted diagnostic criteria. The pathophysiology remains controversial with many theories proposed. Given the clinical manifestations, the complications, outcomes, and lack of popularity of the syndrome, we report a case treated in our institution and review the current pathophysiology and treatment options.