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Neurological Rehabilitation

Paroxysmal Sympathetic Hyperactivity Triggered 13 Months After Severe Traumatic Brain Injury in a 43-Year-Old Male: A Case Report

Thursday, October 23, 2025
5:00 PM - 6:30 PM MT
Location: Open Kiosks

    Poster Presenter(s)

  • Kory Ford, MD (he/him/his)

    Resident Physician
    University of Utah PM&R Program
    Salt Lake City, Utah

    • Co-Author(s)

  • AF

    Alexandra E. Flis, MD

    Physician
    University of Utah PM&R Program
    Salt Lake City, Utah

  • Derrick Allred, MD

    Director or Brain Injury Rehabilitation
    University of Utah Health Craig H. Neilsen Rehabilitation Hospital
    Salt Lake City, Utah

Disclosure(s):
Kory Ford, MD: No financial relationships to disclose
Derrick Allred, MD: No financial relationships to disclose
Case Diagnosis: A 43-year-old male with history of severe traumatic brain injury (TBI) was found to have new-onset paroxysmal sympathetic hyperactivity (PSH) triggered 13 months after initial injury.

Case Description or Program Description: A 43-year-old male with history of severe TBI with open skull fracture requiring craniectomy 13 months prior, with multiple complications prior to eventual definitive cranioplasty two months prior, developed new symptoms consistent with PSH including profound diaphoresis, intermittent tachycardia and hypertension, as well as markedly increased dystonia in all limbs that persisted for four days. This transpired despite no history of dysautonomia, This new clinical presentation developed in the setting of botulinum toxin administration to the right upper extremity and discontinuation of low-dose scheduled gabapentin.

Setting: Inpatient rehabilitation hospital.

Assessment/Results: A diagnosis of PSH was reached after an extensive workup for alternative etiologies was unrevealing. His dysautomina resolved with the resumption of low-dose gabapentin and the initiation of propranolol.

Discussion (relevance): PSH is a common complication after severe TBI, but is typically only seen within the first few weeks after injury. In this patient 13 months out of initial injury, and two months out from any additional procedure or intracranial complication, it appears PSH was triggered in the setting of botulinum toxin injection and stopping gabapentin, without alternative etiology for his symptoms. This is an extremely uncommon presentation of PSH.

Conclusions: This case reports an uncommon presentation of triggered PSH 13 months from severe TBI.