{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T16:26:24Z","timestamp":1792686384820,"version":"4.5.0"},"reference-count":22,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"st1\">\n<jats:title>Background<\/jats:title>\n<jats:p>Paroxysmal sympathetic hyperactivity (PSH) is a severe dysregulation of the sympathetic nervous system, often resulting from traumatic brain injury (TBI). With a prevalence of 10\u201330% in TBI patients, PSH poses diagnostic and therapeutic challenges. This study reviews advancements in diagnosis, management, and outcomes associated with PSH.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st2\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A comprehensive literature review of studies published in the past decade was conducted using PubMed, Scopus, Web of Science, and the Cochrane Library. Keywords included PSH, diagnostic criteria, treatment strategies, and clinical outcomes.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st3\">\n<jats:title>Results<\/jats:title>\n<jats:p>The PSH Assessment Measure (PSH-AM), combining the clinical feature scale and diagnosis likelihood tool, enhances early detection and differentiates PSH from similar conditions. Acute management using opioids and benzodiazepines proved effective, while beta-blockers and alpha-2 agonists reduced episodic recurrence. Despite improved diagnostic accuracy, challenges persist, such as overlapping symptoms and difficulty quantifying autonomic dysfunction. PSH is associated with prolonged hospital stays and poorer neurological outcomes, emphasizing the importance of timely intervention.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st4\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Accurate diagnosis using tools like PSH-AM is essential for mitigating PSH-related complications. Future research should explore biomarkers and personalized therapies to refine diagnosis and optimize long-term outcomes through multicenter trials.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_1130_2024","type":"journal-article","created":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T10:14:44Z","timestamp":1746180884000},"page":"163","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Paroxysmal sympathetic hyperactivity: Current update on diagnosis, treatments, and outcomes"],"prefix":"10.25259","volume":"16","author":[{"given":"Jeremia Aris Pandapotan","family":"Panjaitan","sequence":"first","affiliation":[{"name":"Centre of Evidance Based Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lenny Florentina","family":"Ginting","sequence":"additional","affiliation":[{"name":"Centre of Evidance Based Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirachel","family":"Rajagukguk","sequence":"additional","affiliation":[{"name":"Centre of Evidance Based Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deak Bastian","family":"Sibagariang","sequence":"additional","affiliation":[{"name":"Centre of Evidance Based Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andre Marolop Pangihutan","family":"Siahaan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Universitas Sumatera Utara, Medan, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10894","published-online":{"date-parts":[[2025,5,2]]},"reference":[{"key":"10.25259\/SNI_1130_2024\/ref-1","doi-asserted-by":"crossref","first-page":"580","DOI":"10.5005\/jp-journals-10071-23811","article-title":"Utility of serum procalcitonin in diagnosing paroxysmal sympathetic hyperactivity in patients with traumatic brain injury","volume":"25","author":"Bindra","year":"2021","journal-title":"Indian J Crit Care Med"},{"key":"10.25259\/SNI_1130_2024\/ref-2","first-page":"145","article-title":"Calming the storm: Dysautonomia for the pediatrician","volume":"47","author":"Burton","year":"2017","journal-title":"Curr Probl Pediatr Adolesc Health Care"},{"key":"10.25259\/SNI_1130_2024\/ref-3","doi-asserted-by":"crossref","first-page":"858450","DOI":"10.3389\/fimmu.2022.858450","article-title":"Characteristics and outcomes of paroxysmal sympathetic hyperactivity in Anti-NMDAR encephalitis","volume":"13","author":"Chen","year":"2022","journal-title":"Front Immunol"},{"key":"10.25259\/SNI_1130_2024\/ref-4","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1177\/08830738241276234","article-title":"Paroxysmal sympathetic hyperactivity in childhood tuberculous meningitis: A new association","volume":"39","author":"Jauhari","year":"2024","journal-title":"J Child Neurol"},{"key":"10.25259\/SNI_1130_2024\/ref-5","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1186\/s40064-016-1898-x","article-title":"Paroxysmal sympathetic hyperactivity in brainstem-compressing huge benign tumors: Clinical experiences and literature review","volume":"5","author":"Lee","year":"2016","journal-title":"Springerplus"},{"key":"10.25259\/SNI_1130_2024\/ref-6","doi-asserted-by":"crossref","first-page":"102643","DOI":"10.1016\/j.autneu.2020.102643","article-title":"Risk factors and clinical features of paroxysmal sympathetic hyperactivity after spontaneous intracerebral hemorrhage","volume":"225","author":"Li","year":"2020","journal-title":"Auton Neurosci"},{"key":"10.25259\/SNI_1130_2024\/ref-7","first-page":"e24693","article-title":"Paroxysmal sympathetic hyperactivity after traumatic brain injury: What is important to know?","volume":"14","author":"Louraoui","year":"2022","journal-title":"Cureus"},{"key":"10.25259\/SNI_1130_2024\/ref-8","doi-asserted-by":"crossref","first-page":"2430","DOI":"10.1089\/neu.2018.5963","article-title":"Paroxysmal sympathetic hyperactivity rate in vegetative or minimally conscious state after acquired brain injury evaluated by paroxysmal sympathetic hyperactivity assessment measure","volume":"36","author":"Lucca","year":"2019","journal-title":"J Neurotrauma"},{"key":"10.25259\/SNI_1130_2024\/ref-9","doi-asserted-by":"crossref","first-page":"2047","DOI":"10.1007\/s00701-016-2934-x","article-title":"Paroxysmal sympathetic hyperactivity in severe traumatic brain injury","volume":"158","author":"Mathew","year":"2016","journal-title":"Acta Neurochir (Wien)"},{"key":"10.25259\/SNI_1130_2024\/ref-10","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1016\/S1474-4422(17)30259-4","article-title":"Paroxysmal sympathetic hyperactivity: The storm after acute brain injury","volume":"16","author":"Meyfroidt","year":"2017","journal-title":"Lancet Neurol"},{"issue":"4","key":"10.25259\/SNI_1130_2024\/ref-11","doi-asserted-by":"publisher","first-page":"3000605211009721","DOI":"10.1177\/03000605211009721","article-title":"Efficacy of combination therapy with gabapentin and guanfacine for paroxysmal sympathetic hyperactivity following hypoxic encephalopathy: A case report","volume":"49","author":"Miyoshi","year":"2021","journal-title":"J Int Med Res"},{"key":"10.25259\/SNI_1130_2024\/ref-12","doi-asserted-by":"crossref","first-page":"97","DOI":"10.5005\/jp-journals-10071-24647","article-title":"Paroxysmal sympathetic hyperactivity after traumatic brain injury: Current understanding and therapeutic options","volume":"28","author":"Nasa","year":"2024","journal-title":"Indian J Crit Care Med"},{"key":"10.25259\/SNI_1130_2024\/ref-13","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1016\/j.wneu.2022.03.141","article-title":"Paroxysmal sympathetic hyperactivity in adult patients with brain injury: A systematic review and meta-analysis","volume":"166","author":"Qian","year":"2022","journal-title":"World Neurosurg"},{"key":"10.25259\/SNI_1130_2024\/ref-14","doi-asserted-by":"crossref","first-page":"1815","DOI":"10.3390\/jcm4091815","article-title":"Interrelation between neuroendocrine disturbances and medical complications encountered during rehabilitation after TBI","volume":"4","author":"Renner","year":"2015","journal-title":"J Clin Med"},{"key":"10.25259\/SNI_1130_2024\/ref-15","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1097\/JNN.0000000000000207","article-title":"Pharmacologic management of paroxysmal sympathetic hyperactivity after brain injury","volume":"48","author":"Samuel","year":"2016","journal-title":"J Neurosci Nurs"},{"key":"10.25259\/SNI_1130_2024\/ref-16","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1080\/02699052.2018.1482002","article-title":"Incidence of paroxysmal sympathetic hyperactivity following traumatic brain injury using assessment tools","volume":"32","author":"Samuel","year":"2018","journal-title":"Brain Inj"},{"key":"10.25259\/SNI_1130_2024\/ref-17","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1097\/PHM.0000000000000990","article-title":"Paroxysmal sympathetic hyperactivity and clinical considerations for patients with acquired brain injuries: A narrative review","volume":"98","author":"Thomas","year":"2019","journal-title":"Am J Phys Med Rehabil"},{"key":"10.25259\/SNI_1130_2024\/ref-18","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.jcrc.2018.10.018","article-title":"The use of the PSH-AM in patients with diffuse axonal injury and autonomic dysregulation: A cohort study and review","volume":"49","author":"Van Eijck","year":"2019","journal-title":"J Crit Care"},{"key":"10.25259\/SNI_1130_2024\/ref-19","doi-asserted-by":"crossref","first-page":"34","DOI":"10.4103\/0972-5229.148638","article-title":"Paroxysmal sympathetic hyperactivity in neurological critical care","volume":"19","author":"Verma","year":"2015","journal-title":"Indian J Crit Care Med"},{"key":"10.25259\/SNI_1130_2024\/ref-20","doi-asserted-by":"crossref","first-page":"665183","DOI":"10.3389\/fimmu.2021.665183","article-title":"Paroxysmal sympathetic hyperactivity in severe anti-N-Methyl-d-aspartate receptor encephalitis: A single center retrospective observational study","volume":"12","author":"Wang","year":"2021","journal-title":"Front Immunol"},{"key":"10.25259\/SNI_1130_2024\/ref-21","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/s40120-023-00561-x","article-title":"Paroxysmal sympathetic hyperactivity after acquired brain injury: An integrative review of diagnostic and management challenges","volume":"13","author":"Xu","year":"2024","journal-title":"Neurol Ther"},{"key":"10.25259\/SNI_1130_2024\/ref-22","doi-asserted-by":"crossref","first-page":"81","DOI":"10.3389\/fneur.2020.00081","article-title":"Identification and management of paroxysmal sympathetic hyperactivity after traumatic brain injury","volume":"11","author":"Zheng","year":"2020","journal-title":"Front Neurol"}],"container-title":["Surgical Neurology International"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/surgicalneurologyint.com\/paroxysmal-sympathetic-hyperactivity-current-update-on-diagnosis-treatments-and-outcomes\/","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/paroxysmal-sympathetic-hyperactivity-current-update-on-diagnosis-treatments-and-outcomes\/","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T10:14:48Z","timestamp":1746180888000},"score":1,"resource":{"primary":{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/paroxysmal-sympathetic-hyperactivity-current-update-on-diagnosis-treatments-and-outcomes\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,2]]},"references-count":22,"alternative-id":["10.25259\/SNI_1130_2024"],"URL":"https:\/\/doi.org\/10.25259\/sni_1130_2024","relation":{},"ISSN":["2152-7806","2229-5097"],"issn-type":[{"value":"2152-7806","type":"electronic"},{"value":"2229-5097","type":"print"}],"subject":[],"published":{"date-parts":[[2025,5,2]]},"article-number":"163"}}