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Neurostorming Vs Seizures


What is Neurostorming?

After a severe traumatic brain injury some people may experience neurostorming also known as paroxysmal sympathetic hyperactivity (PSH). According to UpToDate "PSH is defined as a clinical syndrome manifested by paroxysmal episodes of sympathetic activity that occur in patients with severe acute brain injury. Core clinical features include tachycardia, hypertension, tachypnea, hyperthermia, sweating, and/or increased muscle tone with possible dystonic posturing."


The disorder in regulation of the autonomic functions may present with recurrent episodes. UpToDate describes these as "episodes of excessive sympathetic activity that start rapidly, are often induced by stimulation, and resolve spontaneously after a variable period of time or after administration of an abortive medication."


These episodes if occurring in a ICU setting may create a challenge with diagnosis. From The New Gait a list of symptoms of neurostorming include:

  • Temperature more than 101 degrees (38.5 degrees Celsius).

  • Having an abnormally high blood pressure (hypertension)

  • If your heart rate is over 130 beats per minute, get medical attention immediately (tachycardia)

  • Tachypnea is characterized by a rapid breathing rate of more than 40 breaths per minute.

  • Sweating excessively (diaphoresis)

  • Stiff muscles in the arms and legs

  • Back-arched neck and spine and pointing toes (abnormal posturing)

  • Restlessness

  • Increased pupil size

  • Glycogenolysis

  • A higher resting metabolic rate




Seizures in the Intensive Care Unit


The Journal of Clinical Medicine defines "Seizure results from abnormally excessive, neuronal activity as a consequence of the disrupted balance between neuronal excitation and inhibition. What leads to disruption of this balance is not always known. " Several neurological conditions are associated with seizures and status epilepticus including traumatic brain injury.


As sited in the Epilepsy Currents article "Effects of Seizures on autonomic and Cardiovascular Function" seizures can have effect on the autonomic and cardiovascular functions. Seizures typically activate the sympathetic nervous system causing an increase in a person's heart rate and blood pressure. Sympathetic responses predominate during most seizures, causing tachycardia, tachypnea, increased blood pressure, pupillary dilatation, diaphoresis, and facial flushing.


EEG Can Lead to Proper Treatment


The usage of Electroencephalography (EEG) can lead the patients medical team to proper diagnosis. EEG is just one of many tests that a helps the medical determine what is causing changes in their patient. The treatment plan for neurostorming is different than that of seizures. The appropriate treatment will likely lead to an increase in positive patient outcomes.







Sources:

Flint Rehab

https://www.flintrehab.com/storming-after-brain-injury/#:~:text=Neurostorming%20refers%20to%20a%20hyperactive,%2Dor%2Dflight%E2%80%9D%20response.


UpToDate


The New Gait


Epilepsy Currents- Effects of Seizures on Autonomic and Cardiovascular Function

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC531654/#:~:text=Seizures%20typically%20activate%20sympathetic%20nervous,may%20predominate%20during%20partial%20seizures.


Journal of Clinal Medicine- Prevention, Treatment, and Monitoring of Seizures in the Intensive Care Unit

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6722541/pdf/jcm-08-01177.pdf


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