Storming After Brain Injury: Symptoms, Treatment, and Prevention

understanding storming after brain injury

Storming after brain injury is one of the ways your body responds to the stress of a severe injury. It causes distressing symptoms such as elevated heart rate, temperature, and perspiration.

Even though storming is frightening to witness, family members should understand that it is a normal TBI side effect and it does not mean that the person’s condition is deteriorating.

Let’s discuss the causes behind storming after brain injury, as well as symptoms and treatment.

Storming after Brain Injury

Storming after brain injury (also known as sympathetic storming or autonomic dysfunction) refers to an excessive response of the sympathetic nervous system.

The sympathetic nervous system controls your body’s “fight or flight” response, which occurs when your brain detects imminent danger.

When the sympathetic nervous system activates, your body releases adrenaline, which triggers a cascade of responses such as increased heart rate and rapid breathing.

In a healthy person, the sympathetic response helps them handle whatever danger is present. Once the threat passes the parasympathetic response kicks in. This response relaxes the body by lowering blood pressure and bringing the person’s heart rate and breathing back to normal.

After a severe brain injury, however, this process no longer works properly. Because of the damage the brain sustained, it cannot tell whether the body is still in danger or not. As a result, it releases a continuous flood of adrenaline and other hormones into the bloodstream.

But because the brain keeps activating the sympathetic nervous system, the parasympathetic response never gets a chance to calm the body down. That’s when storming occurs.

Symptoms of Storming after Brain Injury

Doctor putting oxygen mask on patient experiencing storming after brain injury

The symptoms of sympathetic storming after brain injury include:

  • Fever over 101 degrees Fahrenheit (38.5 degrees Celsius)
  • Hypertension
  • Heart rate over 130 bpm
  • Respiratory rate over 40 breaths per minute
  • Profuse sweating (diaphoresis)
  • Rigid arm and leg muscles
  • Downward pointed toes and backward arched spine and neck (decerebrate posturing)

Most patients who experience storming after brain injury are in a coma or similar state of consciousness, which means they are not aware of what is happening.

Causes and Prevalence of Storming after Brain Injury

The exact cause of storming after brain injury is unknown.

Researchers know that it is due to increased activity of the sympathetic nervous system, but it remains a mystery why this only happens in some patients and not all.

Some doctors believe it is a sign of recovery from severe traumatic brain injury.

Most storming episodes after brain injury are unprovoked. However, some frequent triggers include:

  • Change in medication
  • Repositioning
  • Environmental stimulation (such as alarms)
  • Fever

Storming occurs in 15-33% of comatose traumatic brain injury patients. It most frequently happens after diffuse axonal injuries and brain stem damage.

Possible Side Effects of Sympathetic Storming

The effects of storming after brain injury can be devastating if left untreated.

Prolonged fever and hypertension can result in secondary brain injuries that will severely harm recovery. High blood pressure and fever can also lead to cardiac failure and kidney dysfunction, among other things.

In addition, decerebrate posturing can cause permanent muscular and skeletal damage if left too long.

That’s why it is crucial to treat storming after brain injury quickly and effectively.

Treating Sympathetic Storming after Brain Injury

Most treatments of sympathetic storming focus on addressing the symptoms.

Lowering blood pressure, bringing down the patient’s heart rate, and eliminating fever are typically the top priorities of the nursing staff.

There are also several medications that suppress sympathetic nervous system activity, which doctors can also give.

How Family and Friends Can Help

Wife sitting with comatose husband, watching for signs of storming after brain injury

Storming after brain injury is a serious condition. However, family members should not worry that their loved one’s condition is worsening if storming occurs. As frightening as storming looks, it is a normal effect of severe TBI.

Still, many people feel helpless when they witness a sympathetic storm. Fortunately, there are ways you can help.

  • Educate yourself and others. Learn the various signs and symptoms of storming after brain injury (such as the ones listed above).
  • Alert nursing staff. Once you know what storming looks like, you can alert nursing staff before symptoms get too severe. Alarms only go off when symptoms are critical, but the actual storm starts well before that. If you see your loved one’s temperature or heart rate start climbing, call for a nurse.
  • Take preventative measures. Using a cool cloth to keep their temperature down, gently massaging their arms and legs, and speaking softly to them can all prevent storming. Even though your loved one might be unconscious, their brain can still react to stress. So try to keep their room calm and relaxing.

These are just a few of the best ways you can help your loved one safely get through storming after brain injury.

Finally, it’s important to remember that storming typically only lasts a few weeks. If all goes well, once it passes, your loved one should begin to recover consciousness again. After that, they will need your help to make a good recovery from brain injury.