What is storming or neurostorming?

After someone has a severe brain injury, they may develop something called Paroxysmal Sympathetic Hyperactivity (PSH). This is also called "storming". It occurs in some patients in a coma after severe brain injury.

Things to look for as signs of storming:

  • High heart rate
  • Fast breathing rate
  • High blood pressure
  • Fever
  • Sweating
  • Tight muscles
  • Unusual body position
  • Restlessness
  • Agitation

Storming can be caused by something inside the person. Sometimes it can be caused by something outside of the person. Examples of causes are:

  • Discomfort or Pain
  • Incontinence
  • Changes in medication
  • How the person is lying or sitting  
  • Being moved in the bed
  • Alarms
  • Noise
  • Fever

Storming can cause more injury to the brain and slows down the healing of the brain. It can hurt other parts of the body as well like the heart, kidneys, or muscles. For most people, storming gets better as the brain gets better. Doctors will check for medical causes like infections or blood clots. They then work to treat the symptoms like pain or high blood pressure to protect the brain and body from more injury. Medication can be used to prevent and treat storming.

    What can I do to decrease storming?

    • Learn the signs of storming.
    •  Tell the nurse or doctor if you see these signs.
    •  Use a cool cloth to keep the temperature down.
    •  Gently massage arms and legs
    •  Speak softly to your loved one. The sound of your voice will help calm them.
    • Keep the room calm and relaxing.

    What kinds of medications can help with storming [Paroxysmal Sympathetic Hyperactivity (PSH)]?

    Medications are frequently used for treating treatment of symptoms related to PSH. Each of the medications listed are FDA-approved treatments for other conditions, but they are not specifically studied in persons with DoC. Medications are tailored to address specific symptoms. General classes of medications that may be used are:

    • Anti-hypertensive medications (also known as “blood pressure medications”) - These medications can be used to lower the blood pressure and heart rate.
    • Anti-pyretic medications - These medications are typically over- the- counter medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen, whichthat can be used to help with fever.
    • Anti-spasticity medications - These medications can be used to help with the muscle tightness that occurs with storming. Refer to the section on “Spasticity” in this material for more information.
    • Pain medications - Some medications, such as gabapentin, can be used to decrease the pain that occurs due to direct brain damage. Other over-the-over the counter medications, such as NSAIDs and acetaminophen, can also decrease pain. In severe cases, the physicians may prescribe opiate medications to decrease pain, but these medications can cause sedation.

    Typically, medications can be weaned as the person recovers and PSH symptoms improve. Talk with your doctor about medications to help with PSH.

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