A Review of Paroxysmal Sympathetic Hyperactivity after Acquired Brain Injury
A Review of Paroxysmal Sympathetic Hyperactivity after Acquired Brain Injury
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DOI：
10.1002/ana.22066
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发表时间：
2010-08-01
影响因子：
11.2
通讯作者：
Menon, David K.
中科院分区：
文献类型：
--
作者：
Perkes, Iain;Baguley, Ian J.;Menon, David K.
严重过度的自主神经过度活跃发生在获得性脑损伤后幸存的亚群中，其中大多数人表现出阵发性交感神经和运动过度活跃。脑损伤后延迟识别阵发性交感神经亢进（PSH）可能会增加发病率和长期残疾。尽管该综合征具有显着的临床影响，但有关该综合征的科学文献却令人困惑。对于命名法尚未达成共识，对疾病发生前诊断的病因学信息知之甚少，支撑我们病理生理学和治疗策略知识的证据基础在很大程度上是轶事。这项系统性文献综述确定了 2 类不同的阵发性自主神经过度活动，其中一类以相对纯粹的交感神经过度活动为特征，另一类则具有混合的副交感/交感神经特征。 PSH组包括349例报告病例，其中79.4%由创伤性脑损伤(TBI)引起，9.7%由缺氧引起，5.4%由脑血管意外引起。尽管 TBI 是主要病因，但有人认为脑缺氧后该病的真实发病率最高。总共为该状况确定了 31 个不同的术语。尽管文献中最常见的术语是自主神经功能障碍，但交感神经临床特征的一致性表明应该使用更具体的术语。本次综述的结果表明，PSH 被采用为一个更具有临床相关性和更合适的术语。该综述强调了有关概念定义、诊断标准和术语的主要问题。建议就这些问题达成共识，作为该领域进一步研究的重要基础。安神经学 2010；68：126-135
Severe excessive autonomic overactivity occurs in a subgroup of people surviving acquired brain injury, the majority of whom show paroxysmal sympathetic and motor overactivity. Delayed recognition of paroxysmal sympathetic hyperactivity (PSH) after brain injury may increase morbidity and long-term disability. Despite its significant clinical impact, the scientific literature on this syndrome is confusing; there is no consensus on nomenclature, etiological information for diagnoses preceding the condition is poorly understood, and the evidence base underpinning our knowledge of the pathophysiology and management strategies is largely anecdotal. This systematic literature review identified 2 separate categories of paroxysmal autonomic overactivity, 1 characterized by relatively pure sympathetic overactivity and another group of disorders with mixed parasympathetic/sympathetic features. The PSH group comprised 349 reported cases, with 79.4% resulting from traumatic brain injury (TBI), 9.7% from hypoxia, and 5.4% from cerebrovascular accident. Although TBI is the dominant causative etiology, there was some suggestion that the true incidence of the condition is highest following cerebral hypoxia. In total, 31 different terms were identified for the condition. Although the most common term in the literature was dysautonomia, the consistency of sympathetic clinical features suggests that a more specific term should be used. The findings of this review suggest that PSH be adopted as a more clinically relevant and appropriate term. The review highlights major problems regarding conceptual definitions, diagnostic criteria, and nomenclature. Consensus on these issues is recommended as an essential basis for further research in the area. ANN NEUROL 2010;68:126-135