Paroxysmal Sympathetic Hyperactivity in Non-traumatic Brain Injury: A Retrospective Analysis From the Intensive Care Unit of a Tertiary Care Academic University

Le résumé fourni par la source

BACKGROUND: Paroxysmal sympathetic hyperactivity (PSH) can occur in comatose patients with a history of non-traumatic brain injury. In the intensive care unit, it is very challenging to diagnose such a condition, as there are a lot of masquerades. METHODS: This was a retrospective study, which screened case records of adult patients (age > 18 years), referred to a 26-bed intensive care unit of a tertiary care academic university, admitted with a comatose state, either post-cardiac arrest status with presumptive diagnosis of hypoxic ischemic brain injury, or patients with suspected meningo-encephalitis for a period of one year. Patient case files suggestive of a history of traumatic brain injury, stroke, epilepsy, and autonomic dysfunction were excluded. Case files with a Paroxysmal Sympathetic Hyperactivity-Assessment Measure (PSH-AM) score ≥17 were included. The case files were reviewed for a period of two weeks starting from the day PSH was diagnosed, and the outcome was assessed in terms of changes in PSH-AM scores and Glasgow Outcome Scale Extended (GOS-E) at ICU discharge. RESULTS: The prevalence of PSH was 17% in comatose patients with hypoxic ischemic encephalopathy (n = 04) and acute meningo-encephalitis (n = 03). There were seven patients with a diagnosis of probable PSH (PSH-AM score ≥17). The median age of the study cohort was 41 years (35-48 years). The median value of severity of illness at ICU admission as assessed by the Acute Physiology and Chronic Health Evaluation II (APACHE II) was 19 (13-21). The median PSH-AM score was 20 (18-21) at the time of diagnosis of PSH, which was 38 days (21-42 days) from the neurological insult. The PSH score reduced to 5 (3-14) after two weeks of treatment (p < 0.001) with propranolol and clonidine. The median GOS-E of the study population was 2 (2-3). CONCLUSION: A high index of suspicion should be kept for diagnosing PSH in patients with non-traumatic brain injury, particularly those with hypoxic brain injury and encephalitis. Episodic tachycardia, hypertension, diaphoresis, and posturing are important features to suspect PSH in comatose patients with a history of non-traumatic brain injury after ruling out other mimics in the ICU, such as sepsis. The PSH-AM score can be helpful in screening for PSH in such patients. Early identification and management of PSH in such critically ill patients can reduce the number of medical interventions.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.