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Feb 25, 2020 · β 1 +β 2 and α blocker (both central and peripheral) exert a stabilizing effect within the central nervous system through indirect inhibition of sympathetic activity . Methods: Prevention: 100–200 mg per 8 h, oral. Target features: Hypertension, tachycardia, and diaphoresis. Advantages
- Rui-Zhe Zheng, Zhong-Qi Lei, Run-Ze Yang, Guo-Hui Huang, Guang-Ming Zhang
- 10.3389/fneur.2020.00081
- 2020
- Front Neurol. 2020; 11: 81.
Aug 26, 2024 · This topic discusses the clinical features, diagnosis, and treatment of PSH. Other aspects of severe TBI are discussed separately. (See "Management of acute moderate and severe traumatic brain injury" and "Traumatic brain injury: Epidemiology, classification, and pathophysiology".)
- Avoid Triggers of PSH
- Best Supportive Care
- Concept #1 – Multimodal Therapy
- Concept #2 – Abortive vs. Preventative Therapy
- Rationale For Aborting An Episode of PSH
- Opioids
- Propofol
- Benzodiazepines
- Propranolol
- Gabapentin
Avoid the use of antipsychotics.(32906174) Patients with PSH may be at increased risk of neuroleptic malignant syndrome.(Louis 2021)Avoid triggers as able (e.g., bladder distention, endotracheal suctioning).Consider pre-treatmentwith opioid or benzodiazepine prior to any unavoidable trigger (e.g., repositioning), if the episodes ensuing are severe.Nutritional support: Patients may have increased resting energy expenditure up to two or three times baseline, which can lead to substantial weight loss.(29939858)Fluid resuscitation: Profuse diaphoresis can promote volume depletion.Fever management: These fevers do not seem to be driven by inflammatory sensors in the hypothalamus, so they may not be responsive to acetaminophen. If the fever poses a risk of secondary brain inj...There is no single “silver bullet” medical therapy for PSH.Most patients will require multimodal therapy:(28816118)Although there is some overlap, different medications are optimal for aborting an episode of PSH versus preventingfuture episodes. Patients will often require a combination of scheduled preventativ...Ideal properties of a medication used to abort an episode of PSH:Ideal properties of a medication used to prevent future episodes of PSH:(1) Diagnostic role – Responsiveness to morphine may also help support the diagnosis of PSH, in situations where this is unclear.(2) Therapeutic role – Uncontrolled paroxysmal sympathetic hyperactivity can cause hyperthermia and hypertension leading to secondary brain injury, as well as discomfort. The urgency with which an...The greatest experience is with morphine, typically at doses of ~2-8 mg IV (but occasionally requiring doses up to 15 mg). Morphine is probably the most effective and preferred agent. If morphine i...Fentanyl may offer the advantage of faster onset, at doses of 25-100 mcg IV.(32476028)This is an excellent option for a patient who is intubated.To abort an episode, a bolus of 10-20 mg of propofol may be used.(32906174)These may be helpful (e.g., in patients with marked tolerance to opioids).The fastest onset may be obtained with IV diazepam (doses of 5-10 mg) or IV midazolam (doses of 2-5 mg).(32906174)General comment: Propranolol is a front-line agent to prevent PSH. Propranolol is lipophilic and exerts direct effects on the brain, making it more effective than most other beta-blockers.Indications/contraindications: Propranolol is contraindicated in patients with bradycardia, decompensated heart failure, hypotension, or heart block.Dose:General comment: Gabapentin may be useful here, with a potential to modulate allodynia and neuropathic pain that triggers episodes. An advantage of gabapentin is that it is often well tolerated for...Indications/contraindications: This is one of the most useful preventative medications. May be especially helpful for patients who also have neuropathic pain.Dose: Start with 300 mg TID. May rapidly uptitrate to a cumulative dose of 3,600 or 4,800 mg/day in patients with normal renal function.(25220846, 28816118)Aug 4, 2023 · The diagnosis and management of autonomic dysfunction are complex and usually require an interprofessional team comprising specialists such as a neurologist, endocrinologist, internist, urologist, and cardiologist. The treatment is symptomatic and usually requires medications, which also have adverse effects.
- 2023/08/04
Jun 1, 2020 · Describe 2 different agents used in the management of paroxysmal sympathetic hyperactivity. Analyze current literature addressing paroxysmal sympathetic hyperactivity management. Discuss 2 pros and cons to each agent that can be used in management of paroxysmal sympathetic hyperactivity.
- Elizabeth A Shald, Jacob Reeder, Michael Finnick, Ishani Patel, Kyle Evans, Rebecca K Faber, Brian W...
- 2020
pathophysiology, symptomatic treatment, and prevention and control of secondary brain injury of PSH in TBI patients. Potential benefits of treatment for PSH may result from the three main goals: eliminating predisposing causes, mitigating excessive sympathetic outflow, and supportive therapy. However, individual pathophysiological differences,
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Nov 13, 2023 · The management of PSH must focus on avoiding allodynic responses, such as minimizing urinary or fecal retention, pain, and noxious stimuli. 6 Treatment emphasizes preventing and terminating paroxysms of sympathetic activity and mitigating downstream sequelae.
