Saturday November 18, 2006
Sympathetic storming

Sympathetic storming after traumatic brain injury remains one of the most dramatic clinical scene particularly in neurological units. It occurs due to episodes of uncontrolled sympathetic surge with a diminished or unmatched parasympathetic response. Acording to Baguley criteria, 5 out of the 7 clinical features should be present -

1. tachycardia,
2. tachypnea,
3. hyperthermia,
4. hypertension,
5. dystonia,
6. posturing, and
7. diaphoresis.

Various agents have been used for symptomatic treatment including versed, morphine, propranolol etc (see review article below) but one thing need to remember: Haloperidol (Haldol) makes symptoms worse.

Dr. Blackman and coll. coined the term "PAID" - paroxysmal autonomic instability with dystonia- in Archives of Neurology March 2004 2.

See great review article here on Sympathetic Storming from Denise M. Lemke, published in J Neurosci Nurs 36(1):4-9, 2004.

References: click to get abstract/article
1. Dysautonomia after traumatic brain injury: a forgotten syndrome? - J Neurol Neurosurg Psychiatry 1999;67:39-43 ( July )
2. Paroxysmal autonomic instability with dystonia (PAID) - Arch Neurol. October 2004;61:1625.
3. Paroxysmal Autonomic Instability with Dystonia After Brain Injury - Arch. Neurol. March 2004;61:321-328