Paroxysmal Sympathetic Hyperactivity in Stroke

Shinsuke Muraoka; Yuki Kumagai; Naoki Koketsu; Yoshio Araki; Ryuta Saito

doi:10.1016/j.wneu.2023.07.002

Paroxysmal Sympathetic Hyperactivity in Stroke

World Neurosurg. 2023 Oct:178:28-36. doi: 10.1016/j.wneu.2023.07.002. Epub 2023 Jul 7.

Authors

Shinsuke Muraoka¹, Yuki Kumagai², Naoki Koketsu³, Yoshio Araki⁴, Ryuta Saito⁵

Affiliations

¹ Department of Neurosurgery, Tosei General Hospital, Seto, Aichi, Japan; Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Aichi, Japan. Electronic address: neuro-smuraoka@umin.ac.jp.
² Department of Community Based Medicine, Fujita Health University, Toyoake, Aichi, Japan.
³ Department of Neurosurgery, Tosei General Hospital, Seto, Aichi, Japan.
⁴ Department of Neurosurgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan.
⁵ Department of Neurosurgery, Nagoya University Graduate school of Medicine, Nagoya, Aichi, Japan.

PMID: 37423330
DOI: 10.1016/j.wneu.2023.07.002

Abstract

Objective: Paroxysmal sympathetic hyperactivity (PSH) is a life-threatening neurological emergency associated with severe brain injury. Stroke-related PSH, particularly post-aneurysmal subarachnoid hemorrhage (aSAH) PSH, has been relatively understudied and is often misdiagnosed as an aSAH-related hyperadrenergic crisis. This study aims to clarify the feature of stroke-related PSH.

Methods: This study discusses the case of a patient with post-aSAH PSH and identifies 19 articles (25 cases) on stroke-related PSH by searching the PubMed database from 1980 to 2021.

Results: In the total cohort, 15 (60.0%) patients were male and the average age was 40.1 ± 16.6 years. The primary diagnoses included intracranial hemorrhage (13 cases, 52.0%), cerebral infarction (7 cases, 28.0%), subarachnoid hemorrhage (4 cases, 16.0%), and intraventricular hemorrhage (1 case, 4.0%). The sites of stroke damage were predominantly the cerebral lobe (10 cases, 40.0%), basal ganglia (8 cases, 32.0%), and the pons (4 cases, 16.0%). The median time of PSH onset after admission was 5 (1-180) days. Most cases employed combination therapy with sedation drugs, beta-blockers, gabapentin, and clonidine. On the Glasgow Outcome Scale, outcomes included death (4 cases, 21.1%), vegetative state (2 cases, 10.5%), severe disability (7 cases, 36.8%), and in only one case (5.3%) was a good recovery noted.

Conclusions: The clinical features and treatment of post-aSAH PSH differed from those of aSAH-related hyperadrenergic crises. Early diagnosis and treatment can prevent severe complications. PSH should be acknowledged as a potential complication of aSAH. Differential diagnosis can aid in developing individualized treatment plans and improving patient prognosis.

Keywords: Aneurysmal subarachnoid hemorrhage; Critical care; Hyperadrenergic crises; Paroxysmal sympathetic hyperactivity; Prognosis; Treatment.

Publication types

Review