Thank you for the exceptional analysis of the pathophysiologic events and factors related with sympathetic storming in the article “Sympathetic Storming After Severe Traumatic Brain Injury” (February 2007:30–38). It certainly presents an explanation for the severe agitation that we have observed in traumatic brain injury cases. I wonder if this autonomic imbalance might also occur in other acute conditions?

Thank you for your letter and your interest. Other central nervous system conditions that sympathetic storming has been reported in include tumors, hydrocephalus, hypoxia, and subarachnoid hemorrhage. In fact, the first case reported in the literature was an individual with a brain tumor.

In hydrocephalus it believed the that the hydrocephalus exhibits pressure on the diencephalon, leading to the catecholamine release. However, in traumatic brain injury cases, there has not been associated hydrocephalus and increases in intracranial pressure have not been reported.

In subarachnoid hemorrhage, the autonomic dysfunction is commonly referred...

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