Paroxysmal sympathetic hyperactivity during traumatic brain injury

Amirhossein Azari Jafari, Muffaqam Shah, Seyyedmohammadsadeq Mirmoeeni, Maryam Sadat Hassani, Shahrzad Nazari, Tristan Fielder, Daniel Agustin Godoy, Ali Seifi

Research output: Contribution to journalReview articlepeer-review

11 Scopus citations


Traumatic brain injury (TBI) is one of the leading causes of disability, morbidity, and mortality worldwide. Some of the more common etiologies of TBI include closed head injury, penetrating head injury, or an explosive blast head injury. Neuronal damage in TBI is related to both primary injury (caused by mechanical forces), and secondary injury (caused by the subsequent tissue and cellular damages). Recently, it has been well established that Paroxysmal Sympathetic Hyperactivity (PSH), also known as “Sympathetic Storm”, is one of the main causes of secondary neuronal injury in TBI patients. The clinical manifestations of PSH include recurrent episodes of sympathetic hyperactivity characterized by tachycardia, systolic hypertension, hyperthermia, tachypnea with hyperpnea, and frank diaphoresis. Given the diverse manifestations of PSH and its notable impact on the outcome of TBI patients, we have comprehensively reviewed the current evidence and discussed the pathophysiology, clinical manifestations, time of onset and duration of PSH during TBI. This article reviews the different types of head injuries that most commonly lead to PSH, possible approaches to manage and minimize PSH complications in TBI and the current prognosis and outcomes of PSH in TBI patients.

Original languageEnglish (US)
Article number107081
JournalClinical Neurology and Neurosurgery
StatePublished - Jan 2022


  • PSH
  • Paroxysmal sympathetic hyperactivity
  • Sympathetic storm
  • TBI
  • Traumatic brain injury

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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