Objective To retrospectively analyze the effects of paroxysmal sympathetic hyperactivity （PSH）on the level of consciousness， functional prognosis and complications of patients with severe stroke. Methods Patients with severe stroke transferred from the neurological intensive care unit （NICU） to our department for rehabilitation from January 2018 to January 2019 were selected. The baseline information， coma recovery scale-revised （CRS-R）， functional independence measure （FIM） and Glasgow outcome scale （GOS） were compared at admission and at discharge， and the incidence of complications during hospitalization were compared between the PSH group （n=11） and the non-PSH group（n=25）. Results Patients with PSH were younger ［（43.60±7.21） vs. （63.25±16.13）， P=0.023］. There was no significant difference between the PSH group and the non-PSH group in CRS-R， FIM and GOS score at admission and at discharge （P＜ 0.05）. There were significant differences in the incidence of hydrocephalus， gastrointestinal tract disease and hypertonia at the unaffected side， which were all higher in the PSH group （6/11 vs.12.00%，P=0.021；8/11 vs. 20.00%， P=0.034；5/11 vs. 4.00%， P=0.006， respectively）. Conclusions PSH did not show any obvious negative effect on the arousal level and functional outcomes in patients with severe stroke. Severe stroke patients with PSH are more likely to have hydrocephalus， gastrointestinal diseases， and hypertonia on the unaffected side. However， given the small sample size of this study， it is necessary to expand the sample size for further observation.