Paroxysmal Sympathetic Hyperactivity: A Structured Approach for Clinical Practice
DOI:
https://doi.org/10.20344/amp.23395Keywords:
Autonomic Nervous System Diseases/diagnosis, Autonomic Nervous System Diseases/epidemiology, Autonomic Nervous System Diseases/etiology, Autonomic Nervous System Diseases/therapy, Brain Injuries, Traumatic/complications, Sympathetic Nervous System/physiopathologyAbstract
Paroxysmal sympathetic hyperactivity is a neurological syndrome characterized by sudden episodes of sympathetic overactivity often triggered by non-noxious stimuli. First described by Wilder Penfield in 1929, it commonly follows severe brain injury and is associated with diffuse lesions involving diencephalic and brainstem structures. Its pathophysiology is not completely understood, but it is believed to result from an imbalance between excitatory and inhibitory pathways within the central nervous system. Diagnosis is clinical, based on exclusion of alternative causes and supported by the Paroxysmal Sympathetic Hyperactivity Assessment Measure. Management includes both pharmacological and non-pharmacological strategies. Despite growing recognition, clinical approaches remain heterogeneous. Further research is needed to clarify mechanisms and develop standardized, evidence-based diagnostic and treatment guidelines to improve outcomes.
Downloads
References
Meyfroidt G, Baguley IJ, Menon DK. Paroxysmal sympathetic hyperactivity: the storm after acute brain injury. Lancet Neurol. 2017;16:721-9.
Scott RA, Rabinstein AA. Paroxysmal sympathetic hyperactivity. Semin Neurol. 2020;40:485-91.
Compton E. Paroxysmal sympathetic hyperactivity syndrome following traumatic brain injury. Nurs Clin North Am. 2018;53:459-67.
Zheng RZ, Lei ZQ, Yang RZ, Huang GH, Zhang GM. Identification and management of paroxysmal sympathetic hyperactivity after traumatic brain injury. Front Neurol. 2020;11:81.
Rabinstein AA. Autonomic hyperactivity. Continuum. 2020;26:138-53.
Louraoui SM, Fliyou F, Aasfara J, El Azhari A. Paroxysmal sympathetic hyperactivity after traumatic brain injury: what is important to know? Cureus. 2022;14:e24693.
Samuel S, Allison TA, Lee K, Choi HA. Pharmacologic management of paroxysmal sympathetic hyperactivity after brain injury. J Neurosci Nurs. 2016;48:82-9.
Xu SY, Zhang Q, Li CX. Paroxysmal sympathetic hyperactivity after acquired brain injury: an integrative review of diagnostic and management challenges. Neurol Ther. 2024;13:11-20.
Godbolt AK, Zampakas A, Nygren Deboussard C. Paroxysmal sympathetic hyperactivity during neurorehabilitation for severe acquired brain injury: current Scandinavian practice and Delphi consensus recommendations. BMJ Open. 2024;14:e084778.
Hilz MJ, Liu M, Roy S, Wang R. Autonomic dysfunction in the neurological intensive care unit. Clin Auton Res. 2019;29:301-11.
Godoy DA, Panhke P, Guerrero Suarez PD, Murillo-Cabezas F. Paroxysmal sympathetic hyperactivity: an entity to keep in mind. Med Intensiva. 2019;43:35-43.
Wang H, Li Y, Shen S, Li X, Li C, Li Y, et al. Hyperbaric oxygen therapy for paroxysmal sympathetic hyperactivity syndrome after brain injury: a multicenter, retrospective cohort study. Med Gas Res. 2025;15:327-31.
Godoy DA, Orquera J, Rabinstein AA. Paroxysmal sympathetic hyperactivity syndrome caused by fat embolism syndrome. Rev Bras Ter Intensiva. 2018;30:237-43.
Monteiro FB, Fonseca RC, Mendes R. Paroxysmal sympathetic hyperactivity: an old but unrecognized condition. Eur J Case Rep Intern Med. 2017;4:000562.
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Acta Médica Portuguesa
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All the articles published in the AMP are open access and comply with the requirements of funding agencies or academic institutions. The AMP is governed by the terms of the Creative Commons ‘Attribution – Non-Commercial Use - (CC-BY-NC)’ license, regarding the use by third parties.
It is the author’s responsibility to obtain approval for the reproduction of figures, tables, etc. from other publications.
Upon acceptance of an article for publication, the authors will be asked to complete the ICMJE “Copyright Liability and Copyright Sharing Statement “(http://www.actamedicaportuguesa.com/info/AMP-NormasPublicacao.pdf) and the “Declaration of Potential Conflicts of Interest” (http:// www.icmje.org/conflicts-of-interest). An e-mail will be sent to the corresponding author to acknowledge receipt of the manuscript.
After publication, the authors are authorised to make their articles available in repositories of their institutions of origin, as long as they always mention where they were published and according to the Creative Commons license.
