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The goals of this study were: (1) to describe the clinical associations and radiological findings of PSH, its incidence, and features in subjects with severe TBI in the intensive care unit (ICU); (2) to investigate the potential role of increased intracranial pressure in the pathogenesis of PSH; and (3) to determine the prognostic influence of PSH during the ICU stay, on discharge from the ICU, and at 12 months post-injury. A prospective cohort study was undertaken of all ICU admissions with severe TBI older than 14 years over an 18-month period. The PSH symptoms consisted of paroxysmal increases in blood pressure, respiratory rate, and heart rate; worsening level of consciousness; muscle rigidity; and hyperhidrosis. Subjects demonstrating PSH episodes were compared with a group of non-PSH consecutive subjects studied over the first 6 months of the study period. Data were recorded on the clinical variables associated with PSH episodes, early post-injury cerebral CT findings, and neurological status at 1 year. Of 179 severe TBI patients admitted over the study period, 18 (10.1%) experienced PSH. Injury severity-related variables (e.g., initial APACHE II score, admission coma level, and proportion with intracranial hypertension) were similar between the two groups. The PSH group had a longer ICU stay and a greater incidence of infectious complications. At 1 year post-injury, 20% of this group demonstrated ongoing PSH episodes. Over 18 months, 10.1% of admissions following severe TBI demonstrated PSH features in ICU. Subjects with PSH had a longer ICU stay and higher rate of complications, although this did not appear to compromise their long-term neurological recovery.<\/jats:p>","DOI":"10.1089\/neu.2011.2033","type":"journal-article","created":{"date-parts":[[2011,12,7]],"date-time":"2011-12-07T18:08:16Z","timestamp":1323281296000},"page":"1364-1370","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":140,"title":["Paroxysmal Sympathetic Hyperactivity after Traumatic Brain Injury: Clinical and Prognostic Implications"],"prefix":"10.1177","volume":"29","author":[{"given":"Juan Francisco","family":"Fernandez-Ortega","sequence":"first","affiliation":[{"name":"University Hospital \u201cCarlos Haya,\u201d","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel Angel","family":"Prieto-Palomino","sequence":"additional","affiliation":[{"name":"University Hospital \u201cCarlos Haya,\u201d","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Garcia-Caballero","sequence":"additional","affiliation":[{"name":"University Hospital \u201cCarlos Haya,\u201d","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Luis","family":"Galeas-Lopez","sequence":"additional","affiliation":[{"name":"University Hospital \u201cCarlos Haya,\u201d","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillermo","family":"Quesada-Garcia","sequence":"additional","affiliation":[{"name":"University Hospital \u201cCarlos Haya,\u201d","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian J.","family":"Baguley","sequence":"additional","affiliation":[{"name":"Westmead Hospital","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2012,5,1]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-007-9021-3"},{"key":"e_1_3_2_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.67.1.39"},{"key":"e_1_3_2_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2008.10.020"},{"key":"e_1_3_2_5_1","doi-asserted-by":"publisher","DOI":"10.1080\/02699050701687375"},{"key":"e_1_3_2_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mehy.2007.04.037"},{"key":"e_1_3_2_7_1","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1977.47.4.0491"},{"key":"e_1_3_2_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/0022-510X(85)90038-3"},{"key":"e_1_3_2_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.61.3.321"},{"key":"e_1_3_2_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0025-6196(11)63647-1"},{"key":"e_1_3_2_11_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.101.6.1644"},{"key":"e_1_3_2_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410210617"},{"key":"e_1_3_2_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01406331"},{"key":"e_1_3_2_14_1","first-page":"8","article-title":"TBI, Colorado, Missouri, Oklahoma and Utah 1990\u20131993","volume":"46","author":"Centers for Disease Control and Prevention","year":"1997","unstructured":"Centers for Disease Control and Prevention. 1997. 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