Paroxysmal Sympathetic Hyperactivity Syndrome: Current State of the Problem and Own Clinical Observation

Traumatic brain injury (TBI) remains one of the main problems in modern neurosurgery and neuroresuscitation. Among the working-age population, severe traumatic brain injury and combined trauma is one of the leading causes of persistent disability. Neurological symptoms, depending on the severity of TBI, vary from focal manifestations, such as central paresis, conduction disorders of sensitivity, disorders of higher cortical functions, to diffuse, such as the development of autonomic dysfunction, central respiratory and cardiovascular disorders, which often negatively affects the prognosis in this category of patients. One of the neurological syndromes complicating the acute period of severe TBI is the syndrome of paroxysmal sympathetic hyperactivity (SPSH). The main manifestations of SPSH are episodes of autonomic dysfunction with the development of tachycardia, arterial hypertension, tachypnea, hyperthermia, hyperemia of the skin, with an increase in the degree of depression of consciousness, increased muscle tone and sweating and irritation of the diencephalic structures on electroencephalography. Clinical manifestations are of the nature of a ‘vegetative storm’. Sympathetic paroxysms can develop from 1 to 15 times a day, with a duration of 10 to 30–40 minutes. The development of SPSH in the clinical picture of severe TBI increases the risk of infectious and hospital complications. Despite the vivid clinical picture, differential diagnostics of SPSH is a complex task due to the need to exclude a large number of comorbid pathologies. The issues of pathogenesis, diagnosis and treatment of SPSH remain unexplored. Assessment scales and algorithms for differential diagnostics of SPSH are being actively introduced into clinical practice, which is certainly of interest to doctors at neurotraumatology centers.