Document Detail

Paroxysmal sympathetic hyperactivity in the neurological intensive care unit.
MedLine Citation:
PMID:  18173907     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To assess the incidence and associations of paroxysmal sympathetic hyperactivity (PSH) among febrile patients in the neurological intensive care unit (NICU). METHODS: Prospective data collection of consecutive patients admitted to an academic NICU for >48 hours. Fever was defined as body temperature >38.3 degrees C (101.0 degrees F) on at least one measurement for two consecutive days. PSH was defined by the transient presence of four of the following six criteria: fever, tachycardia, hypertension, tachypnea, excessive diaphoresis and extensor posturing or severe dystonia in the absence of other potential causes for these clinical signs. Methods: Ninety-three patients were included. Traumatic brain injury (TBI) was the primary diagnosis in 43 patients (46%). PSH were diagnosed in 17 patients (18%). It occurred in 14/43 patients (33%) with TBI but only 3/50 patients (6%) with other primary disorders (p = 0.01). Patients with PSH were younger (mean age: 35 +/- 14 versus 51 +/- 18 years old in the rest of the population) (p = 0.01), although the difference did not reach statistical significance when only TBI patients were included in the analysis (mean age: 35 +/- 15 years old in TBI patients with PSH versus 46 +/- 19 years old in TBI patients without PSH; p = 0.07). Duration of fever in patients with PSH (mean: 10.5 +/- 7 days; median: 9 days) was significantly longer than in the rest of the population (mean: 5.1 +/- 3 days) (p<0.001); the difference remained significant when the analysis was restricted to TBI patients (p = 0.001). CONCLUSION: Episodes of PSH occur in one-third of TBI patients but are rare in other acute neurological conditions. They are more frequent in younger patients and are associated with prolonged duration of fever.
Alejandro A Rabinstein
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Neurological research     Volume:  29     ISSN:  0161-6412     ISO Abbreviation:  Neurol. Res.     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2008-01-04     Completed Date:  2008-02-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7905298     Medline TA:  Neurol Res     Country:  England    
Other Details:
Languages:  eng     Pagination:  680-2     Citation Subset:  IM    
Neuroscience Intensive Care Unit, Jackson Memorial Hospital, University of Miami School of Medicine, Miami, FL, USA.
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MeSH Terms
Age Factors
Autonomic Nervous System Diseases / drug therapy,  epidemiology*,  physiopathology*
Brain / blood supply,  pathology,  physiopathology
Brain Injuries / epidemiology*
Dystonia / epidemiology,  physiopathology
Fever / epidemiology*
Hypertension / epidemiology,  physiopathology
Intensive Care Units / statistics & numerical data*
Length of Stay
Middle Aged
Prospective Studies
Sweat Gland Diseases / epidemiology,  physiopathology
Sympathetic Nervous System / physiopathology*
Tachycardia / epidemiology,  physiopathology
Time Factors

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