Dysautonomia after traumatic brain injury: a forgotten syndrome?

Objectives-To better establish the clinical features, natural history, clin ical management, and rehabilitation implications of dysautonomia after trau matic brain injury, and to highlight difficulties with previous nomenclatur e. Methods-Retrospective file review on 35 patients with dysautonomia and 35 s ex and Glasgow coma scale score matched controls. Groups were compared on i njury details, CT findings, physiological indices, and evidence of infectio ns over the first 28 days after injury, clinical progress, and rehabilitati on outcome. Results-the dysautonomia group were significantly worse than the control gr oup on all variables studied except duration of stay in intensive care, the rate of clinically significant infections found, and changes in functional independence measure (FIM) scores. Conclusions-Dysautonomia is a distinct clinical syndrome, associated with s evere diffuse axonal injury and preadmission hypoxia. It is associated with a poorer functional outcome; however, both the controls and patients with dysautonomia show a similar magnitude of improvement as measured by changes in FIM scores. It is argued that delayed recognition and treatment of dysa utonomia results in a preventable increase in morbidity.