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The Storm That Follows a Traumatic Brain Injury

 March 8, 2017

By  Deborah L Weiner Katz, OTR/L, CCM, CLCP

March happens to be Brain Injury Awareness Month and for the last two years, the Brain Injury Association of America has been honoring this fact with its own campaign, entitled “Not Alone”. Traumatic brain injuries are devastating to the families of those who suffer them and carry a stigma stemming from a general lack of information. A key aspect of our role as advocates is to assist wherever we can in the education of the public regarding these injuries, if only to let TBI sufferers know they are most certainly not alone.

Trauma is trauma regardless of what you name it but when you refer to a disorder as “storming”, you are painting a pretty clear picture for those who might be about to experience or witness it. Storming happens to be the mercifully succinct moniker given to Paroxysmal Sympathetic Hyperactivity (PSH), a nervous system disorder affecting 15 to 33 percent of individuals who have suffered a traumatic brain injury.

Before settling on PSH, the medical community has previously referred to the same condition as “paroxysmal sympathetic storms”, “autonomic dysfunction syndrome”, “fever of central origin” and “acute midbrain disorder.” While there are some alarming keywords in there, including the word ‘storms’, three letters are all we need to break down just what “storming” entails:

  • Paroxysm: A paroxysm simply refers to a sudden relapse or worsening of symptoms. 
  • Sympathetic: This refers to “fight or flight”, a response of the sympathetic nervous system.
  • Hyperactivity: The state of the sympathetic nervous system during “storming” is being described here.

What are the symptoms of storming

A definitive diagnosis does not yet exist. Over the past 20 years, while there have been multiple sets of diagnostic criteria published, there has yet to be a true consensus. These seven symptoms are the best indicators so far:

  1. Increased blood pressure
  2. Rapid heart rate
  3. Rapid breathing
  4. Abnormal muscle tone
  5. High body temperature, of central origin
  6. Muscle stiffness/body positioning
  7. Excessive degree of sweating

No stand-alone test will identify PSH. Symptoms must be presented clinically and consistently, over time.

 What Causes Storming?

The autonomic nervous system controls that which we do not consciously control in our bodies. That includes cardiac muscle, hormonal functions and most other tissues and organ systems. Its proper function depends on a balance between its two components: the parasympathetic system and the aforementioned sympathetic system. The former controls the body’s “rest and digest” functions while the other prepares us for physical activity and other stress, with its “fight or flight” response. The two complement one another. They work together to create balance in the body. If the parasympathetic system is unable to balance its partner, uncontrolled sympathetic responses are the result.

There is a hypothetical chain of events following a traumatic brain injury that may explain storming. After suffering a TBI, a patient starts to receive sedatives or paralytics to reduce swelling of the brain. At that time, it is hard to tell who will incur PSH and who wont. Once the paroxysms begin, they may last for up to 74 days. Once the excessive sweating ceases, storming has probably come to an end. There may still be some abnormal muscle tone or spasticity.

Considering our continued commitment to preventing TBI, we have long considered the experts at Rainbow Rehabilitation Centers to be our friends and allies in continuing to treat and advocate for those who have suffered from traumatic brain injuries. First and foremost, we understand that the families of those who have suffered a brain injury are likely to be the first to notice the symptoms of storming. Treatment does exist in the form of medication that suppresses the central nervous system but that will obviously be handled by a doctor. In the meantime, feel free to contact us for more information on traumatic brain injuries and storming.

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