Joint Session with NCS 

In this Joint Continuous Professional Education Session with the Neurocritical Care Society (NCS), you will learn everything you ever wanted to know about heart-brain interactions and autonomous dysfunction after brain injury - presented by a host of top neurological experts.

The purpose of this transatlantic collaboration is to increase awareness on the condition described below, to summarise the existing research, and to stimulate discussions on a future research agenda.

The "storm after traumatic brain injury" 

The “storm after traumatic brain injury” refers to the excessive adrenergic hyperactivity which can be observed following different types acute brain injury. It has been most frequently described after traumatic brain injury (TBI), with a reported incidence of up to 33%.

Although this is an important and devastating condition, with major clinical and prognostic impact, systematic research and advances in treatment have been hampered in the past by a lack of uniform terminology. Recently, experts have delineated clinical criteria to define this condition, and the term “paroxysmal sympathetic hyperactivity” (PSH) has been proposed as unifying term.

PSH is associated with morbidity, and worse short-term outcomes such as the prolonged need for sedatives, prolonged duration of mechanical ventilation, prolonged hospitalisation, and longer duration of revalidation. Although the manifestations of this condition, hypertension, tachycardia, increased muscle tone and oxygen consumption, and hyperthermia, might contribute to secondary brain damage, it is currently unclear what the long-term consequences of PSH are.

“The recent initiatives to define PSH with clinical criteria, are the first steps of a longer journey to study the causes, consequences, and potential therapies for this condition.” Prognostic implications Geert Meyfroidt (Leuven, Belgium)

Sedative agents, intrathecal baclofen, and adrenergic blocking agents have been proposed as potential therapeutic agents that can be used to suppress the manifestations of PSH, but no prospective randomised trials have been published to study their benefits with regards to outcome, or their potential risks.

Diagnosis and monitoring

Speaker: David Menon (Cambridge, United Kingdom)

Following acute brain injury, some patients develop a clinical state that has been termed “Autonomic Arousal” which consists of an increased basal heart rate and blood pressure, increased sweating, motor posturing, along with excessive response to noxious stimuli.  

In many patients, this settles, but in a subset it persists. This persistent autonomic hyperactivity has been given several labels, but a recent expert consensus recognised the dominant changes were in the sympathetic system, and the current accepted terminology for the syndrome is “Persistent Sympathetic Hyperactivity (PSH)”.  This consensus process has now identified clear diagnostic criteria for PSH, and validation studies are under way. 

"The rigorous methodological tools available will also allow us to identify better characterised patients with PSH for trials of therapy." 
David Menon

This is an important methodological advance, since PSH is known to be associated with longer intensive care and hospital length of stay, and with worse outcome. The rigorous methodological tools available will also allow us to identify better characterised patients with PSH for trials of therapy.  This is critical, since approaches to diagnosis that are not structured an result in misdiagnosis of several confounding states. The tools developed here may also be useful in other conditions of sympathetic hyperarousal.

Continuous Professional Education Session ~ JOINT WITH NCS - RESISTING THE STORM AFTER BRAIN INJURY

01.10.2014, 12:00 – 14:00 - room Berlin

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