Which statement best describes autonomic dysfunction after traumatic brain injury and its typical management?

• A. Chronic chest pain without neurological signs
• B. Dysautonomia with fluctuating heart rate and blood pressure
• C. Seizure activity confined to the morning hours
• D. Localized facial weakness

Answer: (B)

Autonomic dysfunction after traumatic brain injury is a disturbance of autonomic control that leads to unstable cardiovascular function. The most characteristic feature is labile heart rate and blood pressure, often with episodes of tachycardia and hypertension that can occur along with sweating, fever, and agitation during autonomic storms. This description fits best because it centers on the autonomic system’s regulation being disrupted by brain injury, rather than pointing to unrelated symptoms like chest pain without neurologic signs, morning seizures, or isolated facial weakness.

Management aims to stabilize the autonomic responses and reduce triggers. Nonpharmacologic approaches include close vital-sign monitoring, maintaining normovolemia and electrolyte balance, ensuring adequate analgesia and sedation to minimize agitation, and environmental measures to prevent overheating or overstimulation. Pharmacologic strategies commonly involve blunting sympathetic outflow with alpha-2 agonists such as clonidine or dexmedetomidine, using beta-blockers to control tachycardia and hypertension, and employing benzodiazepines for sedation and anxiety. In some cases, medications or infusions to reduce spasticity or additional supportive ICU care are used. The overall goal is to protect cerebral perfusion and support recovery by smoothing these autonomic fluctuations.