阵发性交感神经过度兴奋（PSH）是出血性卒中的少见并发症，在临床工作中容易误诊、漏诊。本文回顾性分析了4例出血性卒中后发生PSH患者的临床资料。其中，患者1、患者3和患者4为重症动脉瘤性蛛网膜下腔出血，患者2为血肿体积较大的脑出血。患者1的PSH与位于右侧额岛叶的血肿有关。患者2的PSH与位于右侧额顶颞岛叶及基底节的巨大囊肿有关。患者3的PSH与脑疝及中脑受压有关。患者4的PSH与脑积水的发生密切相关。所有患者的PSH发作都可通过镇静及镇痛治疗，或可降低颅内压的外科治疗（如引流或分流）终止。本文病例提示若中枢自主神经网络在岛叶、间脑或脑干处出现结构性或功能性的断连，都可能导致PSH的发生。因此，有上述脑区损伤的患者应警惕PSH的发生。

Paroxysmal sympathetic hyperactivity (PSH) is a rare complication of hemorrhagic stroke, thus, it could be easily misdiagnosed and overlooked. The clinical data of four PSH cases after hemorrhagic stroke were retrospectively analyzed. Patient 1, patient 3 and patient 4 suffered from severe aneurysmal subarachnoid hemorrhage. Patient 2 suffered from intracerebral hemorrhage with a large hematoma. PSH of patient 1 was related to a hematoma located in right frontal and insular lobe. PSH of patient 2 was related to a huge cyst which occupied right frontal, parietal, temporal and insular lobe, and right basal ganglia. In the case of patient 3, PSH was associated with cerebral herniation and the compressed midbrain. PSH of patient 4 was strongly related to the development of hydrocephalus. The PSH episodes of all patients responded well to sedation and analgesia treatment, or surgical treatment which could reduce the intracranial pressure, such as drainage or shunt. These cases indicate that both the structural and functional disconnection in insular lobe, diencephalon or brainstem within the central autonomic network could result in the development of PSH. Therefore, patients with lesions in these brain regions should be paid attention to the development of PSH.