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Original research
Risk factors and clinical outcomes of basilar artery occlusion presenting with paroxysmal sympathetic hyperactivity as the initial manifestation: a prospective study
  1. Juntao Yin1,
  2. Wan Wang2,
  3. Yu Wang1,
  4. Yichao Huo3,
  5. Yanan Jia4,
  6. Peng Zhao5,
  7. Yingdong Xu1,
  8. Xiaoqiang Li1,
  9. Guofeng Li1,
  10. Yongmei Kong1,
  11. Yuqing Wei1,
  12. Lixin Guo6
  1. 1Department of Neurology, Xingtai Third Hospital, Xingtai, Hebei, China
  2. 2Department of Neurology, Xingtai People's Hospital, Xingtai, Hebei, China
  3. 3Department of Traditional Chinese Medicine, Xingtai Third Hospital, Xingtai, Hebei, China
  4. 4Department of Science and Education, Xingtai Third Hospital, Xingtai, Hebei, China
  5. 5Department of Interventional Radiology, Xingtai Third Hospital, Xingtai, Hebei, China
  6. 6Department of Cardiac Surgery, Xingtai Third Hospital, Xingtai, Hebei, China
  1. Correspondence to Dr Lixin Guo, Department of Cardiac Surgery, Xingtai Third Hospital, Xingtai 054000, China; lxguocardio{at}


Background Paroxysmal sympathetic hyperactivity (PSH) has been linked to a worse clinical prognosis in patients with traumatic brain injury. We aimed to identify the risk factors and clinical features associated with basilar artery occlusion (BAO) presenting with PSH as the first clinical presentation.

Methods This study recruited patients with acute BAO who received endovascular therapy (EVT) at two stroke centers in China. PSH Assessment Measure ≥8 was included in the PSH+ group, while those with a score below 8 were classified as the PSH− group. Clinical data and radiological findings were compared between the two groups. A binary logistic regression model was employed to identify independent risk factors for PSH.

Results 101 participants were enrolled, of whom 19 (18.8%) presented with PSH as the initial manifestation of BAO. Worse prognosis (modified Rankin Scale score of 4–6) at day 90 occurred in 14 (73.7%) of the PSH+ patients and 42 (51.2%) of the PSH− patients (P=0.076). The 90-day mortality rate was higher in the PSH+ group with 12 (63.2%) participants, compared with 31 (37.8%) participants in the PSH− group (P=0.044). A significantly increased risk of PSH was found in patients with midbrain involvement (OR 6.53, 95% CI 1.56 to 27.30, P=0.01) and a high baseline National Institutes of Health Stroke Scale (NIHSS) score (OR 1.15, 95% CI 1.01 to 1.31, P=0.037).

Conclusions Patients with BAO presenting with PSH as the initial clinical manifestation experience a higher risk of 90-day mortality, despite undergoing EVT. Midbrain infarction and baseline NIHSS score may be significant risk factors for PSH following BAO.

  • thrombectomy
  • stroke

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • YWe and LG contributed equally.

  • Contributors JY, WW, YWe, LG contributed to the conception and design of the study. JY, WW, YWa, YH, YJ, PZ, YX, XL, GL, YK contributed to the acquisition and analysis of data. YWa, YH, YJ, PZ contributed to the clinical assessment of the data. JY, WW contributed to drafting a significant portion of the manuscript. LG and YWe serve as guarantors of this study and accept full responsibility for the work and the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding This work was supported by the Projects in Science and Technique Plans of Xingtai City [grant number 2021ZC108].

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.