The stress response known as sympathetic storming can occur within the first 24 hours after severe traumatic brain injury or up to weeks later. This article reviews the pathophysiology of sympathetic storming, variations in signs and symptoms, potential treatment options, and education of families.

Brain injury is one of the most common types of traumatic injury. In critical care units, patients with moderate to severe brain injury are often intubated and sedated in an effort to diminish the workload of the brain. Agitation or restlessness is common in these patients and can be associated with fever, posturing, tachycardia, hypertension, and diaphoresis. This exaggerated stress response, known as sympathetic storming, occurs in 15% to 33% of patients with severe traumatic brain injury who are comatose (score on Glasgow coma scale [GCS] = 8). Sympathetic storming can occur within the first...

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