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Ep 418 - Neurostorming:"I Have a Client Who . . ."Pathology Conversations with Ruth Werner

A 3D image of a pain receptor.

A young client is comatose after a series of ischemic strokes. They have frequent painful episodes of paroxysmal sympathetic hyperactivity, during which their muscles become spastic and their heart rate and blood pressure rise. Their palliative care team wonders if massage therapy might help the contractures of their limbs, and the massage therapist is willing to try . . . but the results are unexpected.


Neurostorming: Causes, Signs, Risks, and Treatment (2022) NewGait. Available at: (Accessed: 16 February 2024).

Paroxysmal sympathetic hyperactivity - UpToDate (no date). Available at: (Accessed: 14 February 2024).

Zheng, R.-Z. et al. (2020) ‘Identification and Management of Paroxysmal Sympathetic Hyperactivity After Traumatic Brain Injury’, Frontiers in Neurology, 11, p. 81. Available at:

Verma, R., Giri, P. and Rizvi, I. (2015) ‘Paroxysmal sympathetic hyperactivity in neurological critical care’, Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine, 19(1), pp. 34–37. Available at:

Xu, S., Zhang, Q. and Li, C. (2023) ‘Paroxysmal Sympathetic Hyperactivity After Acquired Brain Injury: An Integrative Review of Diagnostic and Management Challenges’, Neurology and Therapy, 13(1), pp. 11–20. Available at:

Author Images
Ruth Werner
Author Bio

Ruth Werner is a former massage therapist, a writer, and an NCBTMB-approved continuing education provider. She wrote A Massage Therapist’s Guide to Pathology, now in its seventh edition, which is used in massage schools worldwide. Werner is also a long-time Massage & Bodywork columnist, most notably of the Pathology Perspectives column. Werner is also ABMP’s partner on Pocket Pathology, a web-based app and quick reference program that puts key information for nearly 200 common pathologies at your fingertips. Werner’s books are available at And more information about her is available at   




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