Neuro Emergencies: Paroxysmal Sympathetic Hyperactivity (PSA)

Question 1

Paroxysmal Sympathetic Hyperactivity
Sympathetic Storming occurs in what % of patients with TBI?
Can occur within what timeframe after TBI?
What is the precise mechanism for the increase in activity of the sympathetic nervous system?

Answer 1

15-30%
the first 24hrs
it’s unknown

Question 2

Clinical Manifestations of PSA include?

Answer 2

Posturing
Dystonia
Hypertension
Tachycardia
Pupillary dilatation
Diaphoresis
Hyperthermia
Tachypnea

Question 3

PSA Treatment
Which Opiate receptor agonists should be used?

Answer 3

Morphine
Fentanyl
Oxycodone

Question 4

PSA Treatment
Which Dopamine agonists should be used?

Answer 4

Bromocriptine

Question 5

PSA Treatment
Which beta-blockers should be used?

Answer 5

Propranolol

Question 6

PSA Treatment
Which alpha-blockers should be used?

Answer 6

Clonidine

Question 7

PSA Treatment
Which GABA agonists should be used?

Answer 7

Midazolam
Diazepam
Clonazepam
Baclofen
Gabapentin