Paroxysmal sympathetic hyperactivity in pediatric traumatic brain injury: A case series of four patients

Deepika, Akhil; Mathew, Manish Joseph; Kumar, Sendhil; Devi, Bhagavatula Indira; Shukla, Dhaval

doi:10.1016/j.autneu.2015.08.003

Cited by 15 publications

(10 citation statements)

References 18 publications

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“…The neuroanatomical basis cannot be ascertained, and involvement of thalami cannot be categorically stated in the pathophysiology of PSH. We have reported PSH in children with severe traumatic brain injury and moyamoya disease [1,2]. The MRI in children with TBI revealed diffuse axonal injury, indicating widespread disruption of central autonomic network.…”

Section: Dear Editormentioning

confidence: 81%

Comment to “Magnetic resonance imaging (MRI) findings of bilateral thalamic involvement in severe paroxysmal sympathetic hyperactivity (PSH): a pediatric case series” by Mrkobrada, et al

Shukla

2015

Childs Nerv Syst

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Section: Dear Editormentioning

confidence: 81%

Comment to “Magnetic resonance imaging (MRI) findings of bilateral thalamic involvement in severe paroxysmal sympathetic hyperactivity (PSH): a pediatric case series” by Mrkobrada, et al

Shukla

2015

Childs Nerv Syst

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“…The reasons by which PSH occurs and its morbid effects have been discussed during years, not only in adult TBI patients but also in pediatric populations and other pathologies [9][10][11][12][13][14][15][16]. Recently Meyer [3] propose that PSH courses in three stages being the first of them asymptomatic because of the strong sedation of the patient and the management of cranial hypertension, the second stage would correspond to the onset of symptom clusters and the third stage would be characterized by dystonia and a decline in posturing.…”

Section: Discussionmentioning

confidence: 99%

“…In summary, this hypothesis of Meyer [3] would indicate that in PSH there will be an increase in the excitatory stimuli without the needed compensatory increase in inhibitory functions. This would lead to a facilitation to develop a highly exaggerated sympathetic efflux triggered by non-nociceptive peripheral stimuli [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20].…”

Section: Discussionmentioning

confidence: 99%

Fever Due to Infection or Muscle Heat?

Devesa

Puell

Castellanos

et al. 2017

MOJAP

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Paroxysmal sympathetic hyperactivity is a frequent condition in patients that suffered a TBI, but also other kinds of brain damage, characterized by a myriad of signs and symptom such as high temperature, tachycardia, tachypnea, hypertension, profuse sweating and spastic extension of legs and arms. The presence of high temperature may lead to suspect about any infective process whose analysis can put at risk the life of the patient, while in fact these symptom appear as a consequence of an increased release of catecholamines occurring because of the disruption of central pathways. Muscle spasticity produces a great heat that contributes to the central origin of hyperthermia. Here we describe two cases that presented PSH after different brain injuries. Both were in coma. One of them after a severe TBI and the other one because of a very important brain infection. PSH in the first case was due to a renal colic and PSH was resolved with propofol. The second case developed PSH suddenly before a session of physiotherapy. The rapid detection of the problem led us to use propranolol and in 40 minutes the patient was in normal conditions. We conclude that the knowledge of PSH and its rapid treatment should be mandatory in hospitals and centers devoted to rehabilitate neurological patients.

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“…This is common in patients between 5 and 35 years old, and corresponds to almost 20% of deaths in this age group (13,14). TBI, a common cause of emergency hospitalization of children, may have a focal lesion -characterized by: contusion, intracranial bleeding and rupture; or diffuse lesion in which there is a focal axonal involvement and volumetric increase of neural tissue (4,14,15).…”

Section: Traumatic Brain Injury and Its Relationship With Age Groupsmentioning

confidence: 99%

Cerebral dysautonomy as a clinical repercussion in children with traumatic brain injury

Silva¹,

Pereira²,

Rabelo³

2020

archpedneurosurg

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Introduction: Dysautonomia or Paroxysmal Sympathetic Hyperactivity (PSH) affects more than 50% of patients suffering from severe traumatic brain injury (TBI), which is a major cause of morbidity and mortality in children under 12 years. The goal is to demonstrate that PSH is established as a consequence in children with severe brain trauma. Methodology: Forty articles were found in databases such as LILACS, Elsevier and Scielo that address the theme, excluding those that addressed the TBI in adults and including those that addressed the theme in the pediatric context and published about the PSH, published until the year of 2019. Results: Severe TBI is established as a common cause of hospitalization of children and PSH as a common consequence. Diagnosis and management of this complication require the help of tools such as "PSH-Assessment Measure (PSH-AM)", which has criteria that facilitate the exclusion of other possible causes and guide the treatment. Non-pharmacological therapeutic measures include control of room temperature and low sensory and pharmacological stimuli to deal with symptoms, such as drugs such as opioids, gabaergic agonists, benzodiazepines and adrenergic antagonists. Conclusion: Severe TBI, a common pediatric emergency, can be considered a predictor of PSH. Even though there is no consensus on the diagnosis, PSH-AM proves to be a reliable alternative to professionals dealing with conditions that may or may not correspond with post trauma dysautonomia. This makes it possible to determine not only the child's clinical condition but also the best therapy to apply.

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Paroxysmal sympathetic hyperactivity in pediatric traumatic brain injury: A case series of four patients

Cited by 15 publications

References 18 publications

Comment to “Magnetic resonance imaging (MRI) findings of bilateral thalamic involvement in severe paroxysmal sympathetic hyperactivity (PSH): a pediatric case series” by Mrkobrada, et al

Comment to “Magnetic resonance imaging (MRI) findings of bilateral thalamic involvement in severe paroxysmal sympathetic hyperactivity (PSH): a pediatric case series” by Mrkobrada, et al

Fever Due to Infection or Muscle Heat?

Cerebral dysautonomy as a clinical repercussion in children with traumatic brain injury

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