A note from Alex about neurostorms...

Miriam is going through some episodes of neuro storms. I thought I would post this so people understood a little better. 

Your brain has 2 centers called the sympathetic (your “get up and go” system) and the parasympathetic (your relaxation system) systems
that keep your body at a steady level of functioning (homeostasis). When there is stress, the sympathetic system releases chemicals
that provide the body with the needed support to respond to the stress. This is called your ”fight or flight” response.
The body’s response to sympathetic release of chemicals:
Increase in heart rate (tachycardia)
Increase in blood pressure (hypertension)
Elevation of temperature (hyperthermia)
Increase in breathing rate (tachypnea)
Increase in muscle tone (dystonia)
Pupils dilate
Sweating (diaphoresis)
Slowing of bowel and bladder activity

The parasympathetic system is responsible for “calming” this response and returning you to a normal state of homeostasis.

Occasionally in individuals who suffer traumatic injury to the brain, there may be episodes when the individual appears to be having a
stress response. The heart will race, breathing becomes rapid and shallow, muscles become tight and rigid, they will sweat profusely,
their temperature shoots up, and they look very uncomfortable or “stressed.” There is not a clear explanation for these episodes, but it is
thought that the sympathetic system overreacts, leading to a stress response; there is a lack of response of the parasympathetic system
to return to a normal state of homeostasis, or a combination of the two.
These episodes can occur without warning or appear to occur spontaneously. The symptoms, as well as the duration of the episode, can
be unpredictable. That is why the nurses refer to this abnormal stress response as neuro storming or sympathetic storming. It commonly
appears as medications used to sedate and control pain are discontinued.
Treatment is aimed at controlling the symptoms, decreasing the frequency of the episodes, or stopping the episodes. The nurses will
also try to identify “triggers” or activities that cause an episode. By identifying a trigger, the nurse can pretreat the individual before the
activity or attempt to avoid the activity.

These episodes may start after your family member has been transferred to the general neurological ward. The episodes do not warrant
return to the intensive care unit (ICU). The storming episodes can generally be controlled with careful adjustment of medications and
care aimed at “calming” the storm. The medications used are aimed at slowing the sympathetic response or acting as the parasympathetic
system.

Family can help by helping to identify triggers, alerting the nursing staff when an episode occurs, and providing calming activities (massage,
relaxing music, conversation, placing cool cloths on the family member’s forehead). If any of these activities cause an episode,
they should be avoided. Identifying the right combination of medications and activities that help “tone” down the episodes takes time.
Medications and activities need to be adjusted on the basis of your family member’s response to the treatment. Generally over time the
sympathetic and parasympathetic systems return to normal or a modified state and the medications can be slowly discontinued.