Autonomic complications of acute brain injury and stroke

Autonomic dysfunction is a frequent and sometimes dangerous complication of acute traumatic or vascular brain injury. Autonomic hyperactivity is the rule, and most often the manifestations are caused by sympathetic excess. Paroxysmal sympathetic hyperactivity is most commonly seen in young patients with severe head trauma, but can be also seen after global cerebral anoxia or acute ischemic or hemorrhagic stroke. Stress-induced cardiomyopathy and cardiac arrythmias can result in hemodynamic compromise and demand careful monitoring. Management of autonomic dysfunction in patients with acute brain injury should be judicious to avoid iatrogenic complications, such as excessive blood pressure reduction leading to cerebral hypoperfusion.