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Manifestations of the hyperadrenergic state after acute brain injury.
MedLine Citation:
PMID:  22322258     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
PURPOSE OF REVIEW: Hyperadrenergic activity leading to autonomic dysfunction after acute brain injury is an underrecognized, yet important source of complications following a variety of neurologic injuries. Autonomic dysfunction may prolong ICU stay and increase healthcare costs driven by extensive diagnostic workups and/or ensuing complications. In this review article, we intend to illustrate commonalities between various hyperadrenergic states in acquired brain injury. Specifically, this review will focus on autonomic dysfunction in two common conditions in the neurocritical care unit, traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH). RECENT FINDINGS: Elevated levels of catecholamines have been well documented in SAH and to a lesser extent in paroxysmal sympathetic hyperactivity, hinting at the underlying increased sympathetic tone in both disease states. The resultant hyperadrenergic state may manifest with vital sign alterations, or end-organ dysfunction such as heart failure. Neuroimaging and limited clinical data have elucidated some information regarding underlying mechanisms, but the gaps in understanding have thus far limited prospective clinical trials. A multitude of therapeutic options to reduce adrenergic tone have been employed with varying degrees of success. SUMMARY: The pathophysiology of autonomic dysfunction is incompletely understood and treatment options are few. However, recognizing hyperadrenergic commonality in disparate neurologic disease may facilitate novel inquiries into lesion localization and therapeutics. It is possible that adrenergic blockade may diminish or abrogate end-organ dysfunction in TBI and SAH.
Authors:
Holly E Hinson; Kevin N Sheth
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-2-8
Journal Detail:
Title:  Current opinion in critical care     Volume:  -     ISSN:  1531-7072     ISO Abbreviation:  -     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-2-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9504454     Medline TA:  Curr Opin Crit Care     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
aDepartment of Neurology and Neurocritical Care, Oregon Health and Science University, Portland, Oregon bDepartments of Neurology, Neurosurgery, Emergency Medicine, Anesthesiology, University of Maryland School of Medicine, R. Adams Cowley Shock Trauma Center, Shock, Trauma, and Anesthesiology Research Center, Baltimore, Maryland, USA.
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