Paroxysmal sympathetic hyperactivity (‘neurostorming’) following traumatic brain injury: a narrative review

Paroxysmal sympathetic hyperactivity (PSH) is a recognized complication of severe traumatic brain injury (TBI), marked by recurrent episodes of excessive sympathetic activity. Despite increasing clinical awareness and research interest, the pathophysiology of PSH is incompletely understood, and both monitoring approaches and optimal management strategies are yet to be clearly established. This narrative review synthesizes current evidence on pathophysiology, clinical features, diagnosis, monitoring tools, and treatment approaches for PSH following TBI.