Identification and Management of Post-Traumatic Paroxysmal Sympathetic Hyperactivity: Role of Beta-Blockers

Abstract

Sympathetic Hyperactivity Syndrome (PSH) is a syndrome characterized by hypertension, diaphoresis, tachycardia and agitation. First described by Penfield in 1929, he called it diencephalic convulsions [1]. However, electrophysiological investigations showed no electro-encephalic activity. Since then, many names have been given to this syndrome including dysautonomia, sympathetic storming, brainstem attack, autonomic dysregulation, and paroxysmal autonomic instability with dystonia. However, it is only very recently in 2014 that the International Brain Injury Association consensus has determined a nomenclature "paroxysmal sympathetic hyperactivity" as well as clear diagnostic criteria through a tool called PSH-AM(Paroxysmal Sympathetic Hyperactivity Assessment Measure). This tool consists of two parts, the first of which rates the severity of the clinical signs from 0-3 and the second part the diagnostic probability. The numerical result of each part is put together and the sum of the two parts gives the probability of a diagnosis of PSH; unlikely (score<8), possible (scores between 8-16) and probable (score ≥ 17) [2-6].