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.
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.
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