From the Guidelines
Paroxysmal sympathetic storming (PSS) should be managed with a focus on supportive care and environmental modifications, as attacks are not medical emergencies and will pass with patience, according to the most recent guidelines 1. When managing PSS, it is essential to understand that the condition is not under the patient's control and should not be blamed on the patient 1. The management approach should prioritize the patient's comfort and safety during episodes.
Key Management Strategies
- Relatives or colleagues should be aware of what a typical attack looks like and know how to respond, which includes not calling an ambulance unless necessary 1.
- Patients can be moved during an attack if necessary and should be placed in a comfortable position, such as lying on their side with a pillow under the head 1.
- Emotional support and comfort should be provided to the patient after the attack, as they may be distressed 1.
- Environmental modifications, such as maintaining a quiet and low-stimulation environment, can help reduce the frequency and severity of episodes.
- Regular monitoring of vital signs and symptom tracking is crucial to assess the effectiveness of the management strategy.
Medications and Interventions
While the provided evidence does not specify medications for PSS, in clinical practice, medications such as beta-blockers, alpha-2 agonists, benzodiazepines, and others may be considered based on the patient's specific symptoms and needs 1.
Outcome Prioritization
The primary goal in managing PSS is to prioritize the patient's morbidity, mortality, and quality of life, focusing on preventing complications and improving the patient's overall well-being. Early recognition and appropriate management of PSS are critical to achieving these outcomes 1.
From the Research
Definition and Characteristics of Paroxysmal Sympathetic Storming
- Paroxysmal sympathetic storming (PSS) is a rare complication of severe traumatic brain injury or cerebrovascular disease, characterized by episodic hypertension, hyperhydrosis, hyperthermia, tachycardia, tachypnea, and extensor posturing 2, 3.
- It is also known as paroxysmal sympathetic hyperactivity (PSH), a life-threatening condition characterized by hyperadrenergic activity and autonomic dysfunction 4, 5.
- The syndrome consists of repeated sudden episodes of tachycardia, tachypnea, hypertension, sweating, and sometimes fever and dystonic posturing 6.
Treatment and Management
- Various medications have been tried in patients with PSS, including morphine, labetalol, codeine, lorazepam, clonazepam, baclofen, propranolol, and clonidine 2, 3, 4, 6.
- Morphine has been found to be highly effective and safe for aborting autonomic crises in patients with PSH 4, 6.
- Reducing external stimulation that can trigger episodes and starting abortive and preventive medications are important aspects of treatment 6.
- Prompt and adequate treatment of PSH may reduce the likelihood of secondary complications, such as dehydration, weight loss and malnutrition, and muscle contractures 6.