Recordings from the 2025 Annual Conference-Clinical Sequelae of TBI After Hyperacute Phase

Video Transcription

Video Summary

The speaker discusses common clinical sequelae of moderate-to-severe traumatic brain injury (TBI), emphasizing early recognition and treatment to improve outcomes and reduce prolonged hospitalization. TBI affects an estimated 56 million people worldwide each year; causes vary by age, with falls especially common among older adults.<br /><br />After describing primary brain injury and ongoing secondary damage, the talk focuses on encephalopathy and post-TBI agitation, paroxysmal sympathetic hyperactivity (“neurostorming”), and dystonia. Agitation may arise during recovery of consciousness and can endanger patients and staff or delay discharge. Clinicians should first investigate and address contributing causes such as infection, metabolic or endocrine abnormalities, medication effects, pain, anxiety, sleep deprivation, and excessive stimulation.<br /><br />For agitation, the speaker recommends reducing environmental triggers and polypharmacy, promoting sleep, and considering scheduled propranolol and atypical antipsychotics. Benzodiazepines are generally discouraged because they may worsen agitation and recovery. Medication selection should account for liver and kidney function and QTc prolongation.<br /><br />Neurostorming involves recurrent sympathetic surges, often with tachycardia, hypertension, fever, sweating, and posturing. Suggested treatments include propranolol and clonidine, with targeted management of fever and discomfort. Gabapentin and baclofen may help dystonia and muscle tone. Treatment should be individualized, with attention to safety, monitoring, and long-term medication needs.

Keywords

traumatic brain injury

TBI

post-TBI agitation

encephalopathy

paroxysmal sympathetic hyperactivity

neurostorming

dystonia

propranolol

clonidine