title: Understanding paroxysmal sympathetic hyperactivity after traumatic brain injury.
abstract: BACKGROUND
  Paroxysmal sympathetic hyperactivity (PSH) is a condition occurring in a small percentage of patients with severe traumatic brain injury (TBI). It is characterized by a constellation of symptoms associated with excessive adrenergic output, including tachycardia, hypertension, tachypnea, and diaphoresis. Diagnosis is one of exclusion and, therefore, is often delayed. Treatment is aimed at minimizing triggers and pharmacologic management of symptoms.
  
  
  METHODS
  A literature review using medline and cinahl was conducted to identify articles related to PSH. Search terms included paroxysmal sympathetic hyperactivity, autonomic storming, diencephalic seizures, and sympathetic storming. Reference lists of pertinent articles were also reviewed and these additional papers were included.
  
  
  RESULTS
  The literature indicates that the understanding of PSH following TBI is in its infancy. The majority of information is based on small case series. The review revealed treatments that may be useful in treating PSH.
  
  
  CONCLUSIONS
  Nurses play a critical role in the identification of at-risk patients, symptom complexes, and in the education of family. Early detection and treatment is likely to decrease overall morbidity and facilitate recovery. Further research is needed to establish screening tools and treatment algorithms for PSH.
authors.affiliation: Kentucky One Healthcare, University of Louisville Hospital, 530 S Jackson St, Louisville, KY 40202, USA.
authors.forename: Kimberly S
authors.initials: KS
authors.lastname: Meyer
keywords: Paroxysmal sympathetic hyperactivity; sympathetic storming; traumatic brain injury