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Paroxysmal Sympathetic Hyperactivity after Traumatic Brain Injury: Clinical and prognostic implications.
MedLine Citation:
PMID:  22150061     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
A proportion of patients surviving severe Traumatic Brain Injury (TBI) present symptoms suggestive of excessive sympathetic discharge, here termed Paroxysmal Sympathetic Hyperactivity (PSH). Aims: 1) To describe the clinical associations and radiological findings of PSH, its incidence and features in subjects with severe TBI in the Intensive Care Unit (ICU). 2) to investigate the potential role of increased Intracranial Pressure in the pathogenesis of PSH, and 3) to determine the prognostic influence of PSH during the ICU stay, on discharge from the ICU, and at 12 months post-injury. Material and methods: A prospective cohort study was undertaken of all ICU admissions with severe TBI older than 14 years of age over an 18 month period. The PSH symptoms consisted of paroxysmal increases in blood pressure, respiratory rate and heart rate, worsening level of consciousness, muscle rigidity and hyperhidrosis. Subjects demonstrating PSH episodes were compared with a group of non-PSH consecutive subjects studied over the first six months of the study period. Data were recorded on the clinical variables associated with PSH episodes, early post-injury cerebral CT findings, and neurological status at one year. Results: Of 179 severe TBI patients admitted over the study period, 18 (10.1%) experienced PSH. Injury severity related variables (eg, initial Apache II, admission coma level, and proportion with intracranial hypertension) were similar between the two groups. The PSH group had longer ICU stay and a greater incidence of infectious complications. At one year post injury, 20% of this group demonstrated ongoing PSH episodes. Conclusion: Over 18 months, 10.1% of admissions following severe TBI demonstrated PSH features in ICU. Subjects with PSH had a longer ICU stay and higher rate of complications, although this did not appear to compromise their long term neurological recovery.
Authors:
Juan Francisco Fernández-Ortega; Miguel Angel Prieto-Palomino; Manuel Garcia-Caballero; Juan Luis Galeas-Garcia; Guillermo Quesada-García; Ian J Baguley
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-12-7
Journal Detail:
Title:  Journal of neurotrauma     Volume:  -     ISSN:  1557-9042     ISO Abbreviation:  -     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-12-13     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8811626     Medline TA:  J Neurotrauma     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Universitary Hospital Carlos Haya, Intensive Care Unit, Avda Carlos Haya s/n, Malaga, Malaga, Spain, 29010, +34690195227; patferon@gmail.com.
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