Mayo Clinic, Department of Neurology, W8B, 200 First Street SW, Rochester, MN 55905, USA.
Curr Treat Options Neurol. 2008 Mar;10(2):151-7. doi: 10.1007/s11940-008-0016-y.
Episodes of paroxysmal sympathetic hyperactivity, sometimes referred to as autonomic storms, are not uncommon in patients with severe traumatic brain injury. Their distinctive characteristics include fever, tachycardia, hypertension, tachypnea, hyperhidrosis, and dystonic posturing. The episodes may be induced by stimulation or may occur spontaneously. Their pathophysiology has not been fully elucidated, but the manifestations clearly indicate activation or disinhibition of sympathoexcitatory areas. These spells are often confused with seizures, leading to unnecessary treatment with antiepileptic drugs. General principles in the management of paroxysmal sympathetic hyperactivity include adequate hydration, exclusion of mimicking conditions (infection, pulmonary embolism, hydrocephalus, epilepsy), effective analgesia, and avoidance of triggers, when identified. The most useful pharmacologic agents are morphine sulfate and nonselective beta-blockers (eg, propranolol). Intrathecal baclofen may be effective in refractory cases. Bromocriptine and clonidine are helpful in some patients, but their efficacy is less consistent. Early recognition and adequate treatment of paroxysmal sympathetic hyperactivity is important to avoid prolongation of the patient's stay in the intensive care unit and to enable recovering patients to participate without restrictions in rehabilitation therapy.
阵发性交感神经过度活动（有时被称为自主风暴）在严重创伤性脑损伤患者中并不罕见。其特征性表现包括发热、心动过速、高血压、呼吸急促、多汗和张力障碍姿势。这些发作可能由刺激引起，也可能自发发生。其病理生理学尚未完全阐明，但这些表现清楚地表明交感兴奋性区域的激活或去抑制。这些发作常与癫痫发作混淆，导致不必要地使用抗癫痫药物治疗。阵发性交感神经过度活动管理的一般原则包括充分水化、排除模拟情况（感染、肺栓塞、脑积水、癫痫）、有效镇痛以及在确定诱因时避免诱因。最有用的药物是硫酸吗啡和非选择性β受体阻滞剂（如普萘洛尔）。鞘内巴氯芬在难治性病例中可能有效。溴隐亭和可乐定对一些患者有帮助，但疗效不太一致。早期识别和充分治疗阵发性交感神经过度活动对于避免患者在重症监护病房停留时间延长以及使恢复中的患者在康复治疗中不受限制地参与非常重要。
