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Vol. 43. Num. 1.January - February 2019
Pages 1-60
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Vol. 43. Num. 1.January - February 2019
Pages 1-60
Review
DOI: 10.1016/j.medine.2018.10.003
Paroxysmal sympathetic hyperactivity: An entity to keep in mind
Hiperactividad simpática paroxística: una entidad que no debería pasar desapercibida
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D.A. Godoya,b,
Corresponding author
dagodoytorres@yahoo.com.ar

Corresponding author.
, P. Panhkec, P.D. Guerrero Suarezd, F. Murillo-Cabezase
a Unidad de Cuidados Neurointensivos, Sanatorio Pasteur, Catamarca, Argentina
b Unidad de Terapia Intensiva, Hospital San Juan Bautista, Catamarca, Argentina
c Shock Room, Hospital Municipal de Urgencias, Córdoba, Argentina
d Departamento de Neurocirugía, Centro Médico ISSEMyM, Toluca, Mexico
e Unidad de Gestión Clínica de Cuidados Intensivos, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain
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Tables (4)
Table 1. Different forms of paroxysmal sympathetic hyperactivity (PSH) nomenclature over time.
Table 2. Disorders sharing signs or symptoms with paroxysmal sympathetic hyperactivity.
Table 3. Diagnostic scale suggested by expert consensus.
Table 4. Drugs used for the treatment of paroxysmal sympathetic hyperactivity.
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Abstract

Paroxysmal sympathetic hyperactivity (PSH) is a potentially life-threatening neurological emergency secondary to multiple acute acquired brain injuries. It is clinically characterized by the cyclic and simultaneous appearance of signs and symptoms secondary to exacerbated sympathetic discharge. The diagnosis is based on the clinical findings, and high alert rates are required. No widely available and validated homogeneous diagnostic criteria have been established to date. There have been recent consensus attempts to shed light on this obscure phenomenon. Its physiopathology is complex and has not been fully clarified. However, the excitation-inhibition model is the theory that best explains the different aspects of this condition, including the response to treatment with the available drugs. The key therapeutic references are the early recognition of the disorder, avoiding secondary injuries and the triggering of paroxysms. Once sympathetic crises occur, they must be peremptorily aborted and prevented. The later the syndrome is recognized, the poorer the patient outcome.

Keywords:
Sympathetic storm
Paroxysmal sympathetic hyperactivity
Catecholamines
Acute brain injury
Severe traumatic brain injury
Resumen

La hiperactividad simpática paroxística es una urgencia neurológica potencialmente letal secundaria a múltiples lesiones cerebrales agudas adquiridas. Se caracteriza por rasgos clínicos de aparición cíclica y simultánea, consecuencia de una descarga simpática exacerbada. El diagnóstico es clínico, requiriendo elevados índices de alerta. Actualmente no existen criterios diagnósticos homogéneos que estén ampliamente difundidos y validados. El consenso reciente intenta arrojar luz sobre este oscuro panorama. Su fisiopatología es compleja y aún no ha sido elucidada con certeza; sin embargo, la teoría basada en el modelo excitación-inhibición es la que mejor explica los distintos aspectos de esta entidad, incluyendo la respuesta a la terapia con los fármacos disponibles. Los pilares terapéuticos se asientan sobre el reconocimiento precoz, evitar insultos secundarios y el desencadenamiento de los paroxismos. De ocurrir crisis simpáticas, es que estas se aborten de forma perentoria y que se prevengan. Cuanto más tarde en reconocerse el síndrome, peores serán los resultados.

Palabras clave:
Tormenta simpática
Hiperactividad simpática paroxística
Catecolaminas
Lesión cerebral aguda
Traumatismo craneoencefálico grave

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