Clinical characteristics and prognosis of paroxysmal sympathetic hyperactivity in patients with severe nontraumatic brain injury

ABSTRACT

Objective

This prospective study investigated and analyzed the clinical characteristics and prognosis of paroxysmal sympathetic hyperactivity (PSH) in patients with severe nontraumatic brain injury.

Methods

Patients presenting with severe nontraumatic brain injury with PSH from July 2018 to June 2019 were enrolled. A PSH assessment measure ≥ 8 points was used as the criterion for PSH. Clinical data, indicators related to PSH, treatment effects and the prognosis were prospectively collected and analyzed.

Results

A total of 220 patients with severe nontraumatic brain injury were analyzed, and PSH occurred in 8 patients (3.6%).     The primary neurological diseases included acute cerebral infarction, anti-N-methyl-D-aspartate receptor encephalitis, hypoxic encephalopathy and acute disseminated encephalitis. The Glasgow Coma Scale score was lower than 8 in the 8 patients with PSH. Seven of these eight patients had a Glasgow outcome scale (GOS) score of 3 or less than 3, and one patient had a GOS of 5 after 6 months. The medicines that effectively controlled PSH included dexmedetomidine, clonazepam, midazolam and diazepam.

Conclusions

Although the incidence was lower for nontraumatic brain injury complicated with PSH than for traumatic brain injury, patients with PSH had a more severe disease state and poorer prognoses. Dexmedetomidine might effectively control PSH.

KEYWORDS:

• Severe nontraumatic brain injury
• paroxysmal sympathetic hyperactivity
• dexmedetomidine
• prognosis

Disclosure statement

No potential conflict of interest was reported by the authors

Ethical standard

All procedures performed were in accordance with the ethical standards of the institutional committee and with the 1964 Helsinki declaration and its later amendments.

Contributorship statement

1. the conception and design of the study: Yan Zhang and He Miao

2. acquisition of data: He Miao, Yan Zhang and Weibi Chen

3. analysis and interpretation of data: He Miao and Huijin Huang

4. drafting the article or revising it critically for important intellectual content: Ying-ying Su, Yan Zhang, He Miao and Huijin Huang

5. final approval of the version to be submitted: all authors.

Additional information

Funding

This work was supported by the National Key Research and Development Program of China [2020YFC2005403]; Beijing Municipal Administration of Hospitals Incubating Program [PX2020035].