Archives of Physical Medicine and Rehabilitation
Volume 90, Issue 4 , Pages 580-586 , April 2009

Diagnosing Dysautonomia After Acute Traumatic Brain Injury: Evidence for Overresponsiveness to Afferent Stimuli

  • Ian J. Baguley, PhD

      Affiliations

    • Brain Injury Rehabilitation Service, Westmead Hospital, Sydney, NSW, Australia
    • Rehabilitation Studies Unit, Faculty of Medicine, University of Sydney, NSW, Australia
    • Corresponding Author InformationReprint requests to Ian J. Baguley, PhD, Brain Injury Rehabilitation Service, Westmead Hospital, PO Box 533, Wentworthville, NSW 2145, Australia
  • ,
  • Melissa T. Nott, PhD

      Affiliations

    • Brain Injury Rehabilitation Service, Westmead Hospital, Sydney, NSW, Australia
  • ,
  • Shameran Slewa-Younan, PhD

      Affiliations

    • Brain Injury Rehabilitation Service, Westmead Hospital, Sydney, NSW, Australia
    • Rehabilitation Studies Unit, Faculty of Medicine, University of Sydney, NSW, Australia
  • ,
  • Roxana E. Heriseanu, MBBS

      Affiliations

    • Brain Injury Rehabilitation Service, Westmead Hospital, Sydney, NSW, Australia
  • ,
  • Iain E. Perkes

      Affiliations

    • Division of Anaesthesia, University of Cambridge Department of Medicine, Addenbrooke's Hospital, Cambridge, UK
    • School of Medicine and Public Health, University of Newcastle, NSW, Australia

References 

  1. Baguley IJ. Autonomic complications following central nervous system injury. Semin Neurol. 2008;28:716–725
  2. Baguley IJ, Slewa-Younan S, Heriseanu RE, Nott MT, Mudaliar Y, Nayyar V. The incidence of dysautonomia and its relationship with autonomic arousal following traumatic brain injury. Brain Inj. 2007;21:1175–1182
  3. Jennett B, Teasdale G. Management of head injuries. Philadelphia: F.A. Davis Co; 1981;p 84-326
  4. Rabinstein AA. Paroxysmal sympathetic hyperactivity in the neurological intensive care unit. Neurol Res. 2008;29:680–682
  5. Baguley IJ, Nicholls JL, Felmingham KL, Crooks J, Gurka JA, Wade LD. Dysautonomia after traumatic brain injury: a forgotten syndrome?. J Neurol Neurosurg Psychiatry. 1999;67:39–43
  6. Fernández-Ortega JF, Prieto-Palomino MA, Muñoz-López A, Lebron-Gallardo M, Cabrera-Ortiz H, Quesada-García G. Prognostic influence and computed tomography findings in dysautonomic crises after traumatic brain injury. J Trauma. 2006;61:1129–1133
  7. Hendricks HT, Guerts ACH, van Ginnekin BC, Heeren AJ, Vos PE. Brain injury severity and autonomic dysregulation accurately predict heterotopic ossification in patients with traumatic brain injury. Clin Rehab. 2007;21:545–553
  8. Rabinstein AA. Paroxysmal autonomic instability after brain injury. Arch Neurol. 2004;61:1625
  9. Baguley IJ, Heriseanu RE, Felmingham KL, Cameron ID. Dysautonomia and heart rate variability following severe traumatic brain injury. Brain Inj. 2006;20:437–444
  10. Lemke DM. Riding out the storm: sympathetic storming after traumatic brain injury. J Neurosc Nurs. 2004;36:4–9
  11. Oh SJ, Hong YK, Song E. Paroxysmal autonomic dysregulation with fever that was controlled by propanolol in a brain neoplasm patient. Korean J Int Med. 2007;22:51–54
  12. Baguley IJ, Heriseanu RE, Cameron ID, Nott MT, Slewa-Younan S. A critical review of the pathophysiology of dysautonomia following traumatic brain injury. Neurocrit Care. 2008;8:293–300
  13. Penfield W, Jasper H. Autonomic seizures (Epilepsy and the functional anatomy of the human brain). In: London: J & A Churchill Ltd; 1954;p. 412–437
  14. Sandel ME, Abrams PL, Horn LJ. Hypertension after brain injury: case report. Arch Phys Med Rehabil. 1986;67:469–472
  15. Boeve BF, Wijdicks EF, Benarroch EE, Schmidt KD. Paroxysmal sympathetic storms (“diencephalic seizures”) after severe diffuse axonal head injury. Mayo Clin Proc. 1998;73:148–152
  16. Russo RN, O'Flaherty S. Bromocriptine for the management of autonomic dysfunction after severe traumatic brain injury. J Paediatr Child Health. 2000;36:283–285
  17. Cuny E, Richer E, Castel JP. Dysautonomia syndrome in the acute recovery phase after traumatic brain injury: relief with intrathecal baclofen therapy. Brain Inj. 2001;15:917–925
  18. Baguley IJ, Cameron ID, Green AM, Slewa-Younan S, Marosszeky JE, Gurka JA. Pharmacological management of dysautonomia following traumatic brain injury. Brain Inj. 2004;18:409–417
  19. Diesing TS, Wijdicks EF. Arc de cercle and dysautonomia from anoxic injury. Mov Disord. 2006;21:868–869
  20. Baguley IJ, Heriseanu RE, Gurka JA, Nordenbo A, Cameron ID. Gabapentin in the management of dysautonomia following severe traumatic brain injury: a case series. J Neurology Neurosurg Psychiatry. 2007;78:539–541
  21. Tong C, Konig MW, Roberts PR, Tatter SB, Li X. Autonomic dysfunction secondary to intracerebral haemorrhage. Anesth Analg. 2000;91:1450–1451
  22. Srinivasan S, Lim CC, Thirugnanam U. Paroxysmal autonomic instability with dystonia. Clin Auton Res. 2007;17:378–381
  23. Bhigjee AI, Ames FR, Rutherford GS. Adult aqueduct stenosis and diencephalic epilepsy (A case report). J Neurol Sci. 1985;71:77–89
  24. Lemke DM. Sympathetic storming after severe traumatic brain injury. Crit Care Nurse. 2007;27:30–37
  25. Biswas AK, Scott WA, Sommerauer JF, Luckett PM. Heart rate variability after acute traumatic brain injury in children. Crit Care Med. 2000;28:3907–3912
  26. Goldstein B, Toweill D, Lai S, Sonnenthal K, Kimberly B. Uncoupling of the autonomic and cardiovascular systems in acute brain injury. Am J Physiol. 1998;275:R1287–R1292
  27. Rapenne T, Moreau D, Lenfant F, Boggio V, Cottin Y, Freysz M. Could heart rate variability analysis become an early predictor of imminent brain death? (A pilot study). Anesth Analg. 2000;91:329–336
  28. Winchell RJ, Hoyt DB. Analysis of heart-rate variability: a noninvasive predictor of death and poor outcome in patients with severe head injury. J Trauma. 1997;43:927–933
  29. Norris PR, Ozdas A, Cao H, et al. Cardiac uncoupling and heart rate variability stratify ICU patients by mortality: a study of 2088 trauma patients. Ann Surg. 2006;243:804–812
  30. Wijnen V, Heutink M, van Boxtel G, Eilander H, de Gelder B. Autonomic reactivity to sensory stimulation is related to consciousness level after severe traumatic brain injury. Clin Neurophysiol. 2006;117:1794–1807
  31. Keren O, Yupatov S, Radai MM, et al. Heart rate variability (HRV) of patients with traumatic brain injury (TBI) during the post-insult sub-acute period. Brain Inj. 2005;19:605–611
  32. Rappaport M, Hall KM, Hopkins K, Belleza T, Cope DN. Disability rating scale for severe head trauma: coma to community. Arch Phys Med Rehabil. 1982;63:118–123
  33. Sacha J, Pluta W. Different methods of heart rate variability analysis reveal different correlations of heart rate variability spectrum with average heart rate. J Electrocardiol. 2005;38:47–53
  34. Malik M. Heart rate variability: standards of measurement, physiological interpretation and clinical use (Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology). Circulation. 1996;93:1043–1065
  35. Bakeman R. Recommended effect size statistics for repeated measures designs. Behav Res Methods. 2005;37:379–384
  36. Tabachnick BG, Fidell LS. Using multivariate statistics. Boston: Pearson Education; 2007;
  37. Bilotta F, Branca G, Lam A, Cuzzone V, Doronzio A, Rosa G. Endotracheal lidocaine in preventing endotracheal suctioning-induced changes in cerebral hemodynamics in patients with severe head trauma. Neurocrit Care. 2008;8:241–246
  38. Leone M, Albanèse J, Viviand X, et al. The effects of remifentanil on endotracheal suctioning-induced increases in intracranial pressure in head-injured patients. Anesth Analg. 2004;99:1193–1198
  39. Baguley IJ. The excitatory:inhibitory model (EIR model): an integrative explanation of acute autonomic overactivity syndromes. Med Hypotheses. 2007;70:26–35
  40. Blackman JA, Patrick PD, Buck ML, Rust RS. Paroxysmal autonomic instability with dystonia after brain injury [published erratum appears in Arch Neurol 2004;61:980]. Arch Neurol. 2004;61:321–328
  41. Wang VY, Manley G. Recognition of paroxysmal autonomic instability with dystonia (PAID) in a patient with traumatic brain injury. J Trauma. 2008;64:500–502

 Supported by the Motor Accidents Authority of New South Wales, Australia (grant no. 02/836).

 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

PII: S0003-9993(09)00060-4

doi: 10.1016/j.apmr.2008.10.020

Archives of Physical Medicine and Rehabilitation
Volume 90, Issue 4 , Pages 580-586 , April 2009