Paroxysmal Sympathetic Storms

Abstract

Paroxysmal sympathetic hyperactivity is a potentially life-threatening complication of many acute neurologic disorders. It manifests with hypertension, tachyarrhythmias, hyperthermia, and hyperhidrosis. It may lead to intracranial hemorrhage, myocardial injury, fatal tachyarrhythmias, and neurogenic pulmonary edema. Common causes include head trauma, subarachnoid hemorrhage, brain stem lesions, autonomic dysreflexia, Guillain–Barré syndrome, and drug intoxication. Potential mechanisms include limbic seizures, activation of hypothalamic or brain stem sympathoexcitatory areas, segmental sympathetic reflexes, baroreflex failure, and activation of peripheral adrenergic receptors. Sympathetic hyperactivity should be managed in an intensive care unit. Management includes recognition and management of triggering factors such as pain. Drugs should be used with caution.