Paroxysmal Sympathetic Hyperactivity (PSH) or “storming” is a phenomenon characterized by a person’s inability to regulate their sympathetic “fight or flight” responses. During these episodes, an individual appears to be having a stress response and their brain is not able to control the reaction. This can be triggered by things like pain, discomfort, or other stimulation.
Storming is typically seen in patients with severe brain injuries that are in a coma or minimally conscious state.
Signs of “storming” episode may include:
- Fast heart rate (often over 100 beats per minute)
- High blood pressure
- Rapid and shallow breathing
- Muscle stiffness, tightness, or unusual posturing of arms or legs
- High temperature or sweating
Treatment for Storming may include any of the following:
- Medicines to help with pain, heart rate, and blood pressure
- Keeping the room quiet and calm
- Lowering noise, lights, and other stimulation
- Cool cloths on the face, head, or neck
- Therapy to help with positioning and gentle movement to prevent stiffness
Paroxysmal Sympathetic Hyperactivity or “storming” can be challenging, but with early recognition, a calm environment, and coordinated medical and therapy management, symptoms can often be reduced and better controlled. Caregiver support plays an important role in identifying possible triggers, maintaining comfort, and helping protect the patient from secondary complications while the brain heals.