Paroxysmal sympathetic hyperactivity in pediatric traumatic brain injury: A case series of four patients.
Paroxysmal sympathetic hyperactivity (PSH) is a condition in which there is extreme autonomic dysregulation leading to multiple episodes of sympathetic hyperactivity. Its occurrence after traumatic brain injury (TBI) in pediatric population is a neglected scenario. In our series, all pediatric patients with moderate and severe head injuries were studied and those patients who developed PSH were monitored for the PSH episodes. Four children out of 36 cases of pediatric severe traumatic brain injury developed features of PSH. Admission GCS of 3 children were 4/15 and 1 child was 6/15 and each of them had an ICU stay of more than 2 weeks and a poor DRS score at discharge. The presence of PSH is known to produce poorer outcome in terms of overall mortality, time needed for recovery, chances of developing infections, etc. which was also seen in these cases presented here. Though some studies have provided guidelines for the management of PSH like symptomatic management and use of drugs like clonidine, bromocriptine, benzodiazepines, and gabapentin, strict management guidelines are not established and exact incidence in pediatric population is not determined.
Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 560029, India.
Akhil
A
Deepika
Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 560029, India.
Manish Joseph
MJ
Mathew
Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 560029, India.
S Arun
SA
Kumar
Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 560029, India.
Bhagavatula Indira
BI
Devi
Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 560029, India. Electronic address: neurodhaval@rediffmail.com.
Dhaval
D
Shukla
D000293:Adolescent; D001342:Autonomic Nervous System Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology* / Q000628:therapy; D001930:Brain Injuries / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D002648:Child; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D011379:Prognosis
Autonomic dysregulation; Diffuse axonal injury; Paroxysmal sympathetic hyperactivity; Traumatic brain injury