The use of the PSH-AM in patients with diffuse axonal injury and autonomic dysregulation: A cohort study and review

Identification and Management of Paroxysmal Sympathetic Hyperactivity After Traumatic Brain Injury

“…Previous and recent cases provide evidence that PSH-AM can not only serve as reliable diagnostic criteria, but also stratify the severity of PSH (10,57). The tool is able to dynamically monitor the evolution of individual PSH patients' clinical status, and is also valuable in diagnosing PSH in different types of brain trauma [e.g., diffuse axonal injury; (57,58)]. Given that further assessment and inspection due to persistent symptoms is necessary in the treatment of patients with TBI, PSH-AM can help to avoid misdiagnosis, enhance diagnostic efficiency, save time, and reduce economic costs.…”

Paroxysmal Sympathetic Hyperactivity

“…Rates ranging from 8 to 33% have been reported among various cohorts of patients with severe TBI. 5,8,[11][12][13][14][15] These studies have varied in the type of population included, the time of the clinical assessment, the diagnostic criteria used to make the diagnosis of PSH, and the specific clinical setting (intensive care unit [ICU] vs. rehabilitation unit). A consistent finding has been that PSH is more frequent in young and comatose patients.…”

“…Instead, global, diffuse or multifocal cerebral injury is typically present. Neuroimaging studies have noted the association of PSH with diffuse axonal injury 14,19 and injuries affecting the periventricular white matter, corpus callosum, diencephalon, and upper brain stem. 20,21 Studies employing diffusion tensor imaging magnetic resonance imaging have shown that PSH is more common when there is disconnection of the white matter tracts involving the posterior corpus callosum and posterior limb of the internal capsule.…”

“…These two components are combined in a score that reflects the degree of confidence in the diagnosis of PSH. The feasibility and reliability of these tools have been validated, 14 and there is some evidence that they may reduce the chances of misdiagnosis and favorably impact hospital length of stay and costs of hospitalization. 25 The Clinical Feature Scale could also be used to monitor the severity of episodes over time, thus serving as a possible endpoint for future interventional studies.…”

“…1,2 Prognosis PSH is associated with worse clinical outcomes after TBI, both short-term and long-term. 1,3,5,12,14 Prognosis is also worse in pediatric patients with TBI who have PSH. 35 Yet, it is unclear whether this association of PSH with worse prognosis is due to the preferential occurrence of PSH in patients with more severe brain injury (in which case PSH would be only a surrogate marker for disease severity rather than a factor influencing the prognosis per se) or to a direct detrimental effect of PSH on prognosis.…”