2. Mostafa Mohamed
Mohamed Tarek
Omer Mahrous
Momen Khaled
Mohamed Sameh
221100669
221101510
221101272
221100640
221100620
Our Team
Sama Naser
221100885
Nora khaled
221100706
Sara Said
22101418
Nada ELsayed
221101315
Nourhan Elsayed
221101513
Ahmed Salama
Omer Abdullah
Seif Elden Ahmed
Mohamed Ayman
Zyad Ehab
221100079
221100733
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221101056
Under Supervision of :
DR . Eman Kolieb
3. Table of
content Definition & Physiological
Background.
Causes of PSH.
Episodes of PSH.
Treatment of PSH.
Case study.
1.
2.
3.
4.
5.
4. Definiation of PSH
After acute brain damage ( 60% -
80% )
Occurs after traumatic brain
injury.
Stroke.
Meningitis.
It is a type of
sympathetic
hyperactivity
It is a disorder :
5.
6. Physiological Background
Defined as simultaneous increases ( hyperactivity) in the
function of symapthetic system as:
Elevated heart rate
Blood pressure
Respiratory rate
Temperature
Sweating
Motor ( posturing ) activity
7. Causes
At normal conditions In PSH
Descending inhibitory pathways
from cortical inhibitory areas
exert a negative modulatory
activity on sympathetic centers in
diencephalon , brainstem and
spinal cord .
Results from a loss of these
inhibitory pathways, and this
way occurs due to damage to
the white matter tracts in the
posterior limb pf internal
capsule and damage in
posterior corps callosum .
Eg. ( due to diffusion of axonal
injury following the trauma)
8.
9. Episodes
of PSH
This will lead to :
- Pupillary Dilatation
- Decreased production of saliva and decreased blood flow to
the glands
- Tachycardia
- Tachypnea
- increased output of glucose from the liver and inhibition of
insulin release from the pancreas
- muscles along the digestive tract and decreases secretions
needed for proper digestion
- release of noradrenaline, which acts upon alpha- and beta-
adrenergic receptors.
- Tonic Posturing (motor activity)
-Others e.g(Fever and Hyperthermia)
10.
11. Treatment
Treatment
Patient must be taken to the intensive care unit ( ICU), and
take treatment related events such as prolonged
respiratory support.
Patient should take a rest at least 2 weeks ( 14 days ), and
reduce stimulations of sympathetic nervous system as
much as possible.
12. Medications could help as :
1- Morphine helps lower respiration rates & hypertension
(Nausea & vomitting are common side effects)
2- Clonidine is an alpha receptor agonist that help in reducing
sympathetic activity, and it is helpful in lowering
blood pressure and heart rate , it may also
increase sympathetic inhibition in the
brainstem.
14. A 35-year-old male was admitted to our center after sustaining a
head injury during a road traffic accident. At presentation, his X-
Ray shows that he had multiple hemorrhagic contusions, he was
doing well and recovering but on 8th day of admission he
developed episodes of fever, tachycardia and hypertension
along with dystonic posturing, each episode lasted for a few
minutes and there were several such episodes per day. Patient
was diagnosed to be suffering from PSH. He taken to (ICU), and
he treated using clonidine 0.1 mg thrice a day. The frequency of
these episodes reduced markedly on this treatment after several
days, and these episodes stopped after 20 days.
16. Q1- All of this choices are correct about sympathetic hyperactivity ,
except:
A- Mydriasis ( Pupillary Dilatation)
B- Increased Systolic & Distolic blood pressure
C- Exerts an inhibitory effect upon gastrointestinal muscles
D- Decreased respiratory rate
Q2- According to episodes of paroxysmal Sympathetic Hyperactivty
(PSH) , which one is true:
A- Bradycardia
B- Hypotension
C- Increased heart rate
D- Decreased respiratory rate
