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Storming After Brain Injury: Understanding Paroxysmal Sympathetic Hyperactivity

doctors rushing to help patient who is storming after brain injury

Storming after brain injury is one of the ways a patient’s body responds to the stress of a severe traumatic brain injury (TBI). It causes distressing signs to the body such as a high heart rates, elevated temperature, and unnatural body posturing.

Although storming can be frightening to witness, family members should understand that it is a frequent secondary effect after TBI  and may even indicate increased brain activity.

This article will discuss the causes behind storming after brain injury, as well as symptoms and treatment.

What is Storming after Brain Injury? 

Storming after brain injury refers to an excessive response of the sympathetic nervous system (SNS). The SNS controls your body’s “fight-or-flight” response that activates in the presence of imminent danger.

When the SNS is triggered, your body releases adrenaline to prepare the body for “fighting” or “fleeing.” As a result, this response increases the heartrate and breathing rhythm and places the body on high alert.

In a healthy person, the fight-or-flight response allows he/she to handle whatever danger is present. Once the threat passes, the parasympathetic nervous system (PNS) kicks in to relax the body. It does so by lowering blood pressure and bringing heart rate and breathing rhythm back to normal.

After a severe brain injury, however, this response no longer functions properly. Due to damage sustained during the injury, the brain cannot accurately determine whether or not the body is still in danger. It therefore releases a continuous flood of adrenaline and other hormones into the bloodstream.

But, because the brain is damaged, the PNS cannot act to calm the body down. As a result, the body enters a state called paroxysmal sympathetic hyperactivity, also known as storming.

Signs of Paroxysmal Sympathetic Hyperactivity

young woman in hospital bed, unconscious and receiving oxygen because she is storming after brain injury

Storming is a sudden, physical response with specific signs that are easy to identify. The most common signs of paroxysmal sympathetic hyperactivity include: 

  • Fever over 101 degrees Fahrenheit (38.5 degrees Celsius)
  • High blood pressure
  • Heart rate over 130 beats per minute
  • Breathing rate over 40 breaths per minute
  • Profuse sweating (diaphoresis)
  • Rigid arm and leg muscles
  • Downward pointed toes and backward arched spine and neck (abnormal 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. Storming typically appears within the first few hours or days after injury but can continue for several weeks or months after.

Causes and Prevalence of Storming after Brain Injury

Storming occurs in 15-33% of patients who are in a coma after a brain injury.

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

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

Storming usually occurs after severe traumatic brain injuries and is frequently associated with hypoxic injuries, intracerebral hemorrhages, and hydrocephaly.

The exact cause of storming is not clear. Researchers know that it is due to increased activity of the SNS, but why this only happens in some, but not all, remains a mystery.

Is Neurostorming a Sign of Recovery?

Neurostorming typically occurs as the person progresses through the stages of recovery. In particular, the increase in sympathetic activity may be a sign of increased brain activity.

However, while neurostorming may be an initial positive sign, the effects of storming after brain injury can be devastating if left untreated. 

For example, prolonged fever and high blood pressure can result in secondary brain injuries that will severely prolong recovery. These complications can also lead to cardiac failure and kidney dysfunction, among other things.

In addition, abnormal posturing can cause permanent muscular and skeletal damage if left too long. Therefore, it is crucial to treat storming after brain injury quickly and effectively.

Most treatments of sympathetic storming use medication to address the complications, such as lowering the person’s blood pressure and/or eliminating the fever. 

How Family Members Can Help Prevent Storming

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 storm. Fortunately, there are several ways you can help:

  • Educate yourself and others. Learn the various signs 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 complications get too severe. If you see changes in your loved one’s temperature or heart rate, call for a nurse.
  • Take preventative measures. Finally, you can take steps to prevent storming from occurring. For example, using a cool cloth to keep their temperature down, gently massaging their arms and legs, and speaking softly to them are all effective measures. 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.

Above all, 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.

Featured Image: ©iStock/gorodenkoff

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