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Nurs Clin North Am. 2018 Sep;53(3):459-467. doi: 10.1016/j.cnur.2018.05.003.

Paroxysmal Sympathetic Hyperactivity Syndrome Following Traumatic Brain Injury.

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Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, 1161 21st Avenue South MCN D-2106, Nashville, TN 37232-2447, USA. Electronic address:


Paroxysmal sympathetic hyperactivity (PSH) is a syndrome classified by episodic presentation of abnormal sympathetic and motor symptoms observed in patients with acquired brain injuries. Although the exact physiologic mechanism of PSH is not fully understood, its clinical significance has been well-established. PSH diagnosis depends on the identification of symptom presence, severity, and patterns. Treatment of PSH is rooted in pharmacologic management of targeted symptoms. Although complex, recognition and management of PSH has meaningful implications on the hospitalization and recovery trajectory for adult patients with traumatic brain injuries.


Autonomic dysfunction; Paroxysmal sympathetic hyperactivity (PSH); Sympathetic storming; Traumatic brain injury (TBI)

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