Abstract
A small proportion of patients who survive severe traumatic brain injury (TBI) have symptoms suggestive of excessive sympathetic discharge, here termed “paroxysmal sympathetic hyperactivity (PSH)”, otherwise known as dysautonomia. PSH prolongs the ICU stay and is detrimental to the recovery of patients. This report presents two cases of PSH after severe TBI. Both patients had an admission Glasgow come scale (GCS) score of 4, and the onset of clinical episodes of PSH occurred on the seventh post-traumatic day in case 1 and on the first day in case 2. Both patients had episodes every day until the administration of gabapentin controlled the paroxysmal autonomic changes. PSH is an under-recognized, yet important, source of complications following TBI. The timely recognition of the clinical presentation of PSH is therefore important for intensivists.
