Neurology and Neurosurgery

Biography

Biography: Arun Oommen

Abstract

PSH commonly occurs in about 15-33% of patients following severe head injury if  associated with at DAI, Brain stem Injury, preadmission hypoxia or in the younger age group. The management of PSH following severe traumatic brain injury (TBI) remains problematic, primarily due to an inadequate understanding of the pathophysiology of the condition. PSH exerts a profound negative influence on the final outcome in affected individuals.

The pathophysiological basis  by  recent evidences  support two recent hypothesis –

1. Direct injury to the  Hypothalamus

2. Functional  disconnection of the hypothalamus and diecephalon from rest of  the CNS.

PSH aggravates secondary brain injury by basically 3 mechanisms,

• Hyperthermia,

—  Rigidity and posturing

—  Elevation of circulating catecholamines

DD includes-Lethal catatonia ,Malignant hyperthermia ,Infection ,Serotonin syndrome , Delirium Tremens (DTs),Dystonias, Meningitis, Neuroleptic Malignant Syndrome, Pediatric Sepsis, Thyroid Storm

Management include -Physical Therapy, Occupational Therapy, Speech Therapy. Drugs like Alpha-adrenergic and beta-adrenergic blockers Bromocriptine Chlorpromazine, Dantrolene Morphine ,Propranolol are helpful.

While the original theories inferred an epileptogenic source, there is greater support for disconnection theories.