title: Intractable Central Hyperthermia in the Setting of Brainstem Hemorrhage.
abstract: Hyperthermia from a central cause is associated with increased morbidity and mortality. Dysfunction of brainstem thermoregulatory pathways may explain the intractable rise in temperature. Antipyretics, dantrolene, bromocriptine, and surface and intravascular cooling devices have been attempted for temperature control. We report the case of a 54-year-old woman with history of hypertension who presented with pontine hemorrhage with extension into the midbrain and medulla. On days 8-9 of her hospital admission, she developed intractable fever and expired the same day despite aggressive treatment of hypothermia, including antipyretics, ice lavage, cold fluid boluses, surface cooling, dantrolene, and bromocriptine. Hyperthermia from brainstem hemorrhage can be difficult to manage with current treatment options. Early recognition of those patients who may develop hyperthermia could lead to early intervention and possibly better outcomes. More evidence from prospective randomized controlled trials will elucidate the risk-benefit profile of achieving normothermia with aggressive fever control in these patients.
authors.affiliation: Department of Neurology, University of Texas Southwestern Medical Center , Dallas, Texas.
authors.forename: Niyatee
authors.initials: N
authors.lastname: Samudra
authors.affiliation: Department of Neurology, University of Texas Southwestern Medical Center , Dallas, Texas.
authors.forename: Stephen
authors.initials: S
authors.lastname: Figueroa
mesh_terms: D058633:Antipyretics / Q000008:administration & dosage; D001933:Brain Stem / Q000000981:diagnostic imaging*; D020526:Brain Stem Infarctions / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D001971:Bromocriptine / Q000008:administration & dosage; D018491:Dopamine Agonists / Q000008:administration & dosage; D061345:Early Medical Intervention / Q000379:methods; D005260:Female; D005334:Fever / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D020299:Intracranial Hemorrhage, Hypertensive / Q000150:complications*; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D058633:Antipyretics; D018491:Dopamine Agonists; D001971:Bromocriptine