Paroxysmal sympathetic hyperactivity: Autonomic instability and muscle over-activity following severe brain injury

Abstract

Background: Children who suffer from moderate-to-severe brain injury can develop a complicating phenomenon known as paroxysmal sympathetic hyperactivity (PSH), characterized by autonomic instability and identified clinically as a cluster of symptoms that can include recurrent fever without a source of infection, hypertension, tachycardia, tachypnea, agitation, diaphoresis and dystonia. Studies with adults have demonstrated that this cluster of symptoms is associated with poorer clinical outcomes (prolonged hospitalizations, poorer cognitive and motor function). However, there have been limited studies in children with PSH.

Objective: To present a literature review regarding PSH following severe brain injury and highlight research needs in children with PSH.

Methodology: Electronic databases (CINAHL, Ovid Medline, Web of Science and Google Scholar) were searched.

Results: Thirty-one research articles met the criteria for inclusion. Several themes emerged regarding the phenomenon of interest during the review: nomenclature, symptoms, management and differences between children and adults.

Implications: The majority of the research regarding PSH following severe brain injury has been descriptive in nature. Few studies, however, have explored PSH in children with brain injury; therefore, little is known about whether the outcomes of children with PSH are different and, if so, in what ways.

Keywords:

• Adult and child
• autonomic dysfunction
• brain injury
• dysautonomia
• fever
• hypertension and nursing intervention

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.