Whether to Proceed With Deep Brain Stimulator Battery Change in a Patient With Signs of Potential Sepsis and Parkinson Hyperpyrexia Syndrome: A Case Report.
Parkinsonism-hyperpyrexia syndrome (PHS) is a neurologic emergency associated with anti- Parkinson medication withdrawal; however, its clinical presentation mimics sepsis. We describe the case of a 69-year-old man with advanced Parkinson disease who presented for exchange of the depleted battery in his subthalamic deep brain stimulator. The patient's preoperative symptoms of fever, rigidity, altered consciousness, and autonomic instability presented a dilemma whether to proceed with battery exchange to treat PHS or postpone surgery due to potential sepsis. The administration of dopaminergic medications, dantrolene, and antipyretic drugs are temporary supportive measures, while prompt restoration of deep brain stimulator function is the most important therapeutic treatment for PHS.
From the Departments of *Anesthesiology; †Neurosurgery; and ‡Pediatrics, Albany Medical Center, Albany, New York.
Chyong-Jy Joyce
CJ
Liu
Anica
A
Crnkovic
John
J
Dalfino
Leina Yoko
LY
Singh
D000368:Aged; D000066491:Clinical Decision-Making; D046690:Deep Brain Stimulation / Q000295:instrumentation*; D019468:Disease Management; D011211:Electric Power Supplies; D006801:Humans; D008297:Male; D008305:Malignant Hyperthermia / Q000628:therapy*; D010300:Parkinson Disease / Q000150:complications / Q000628:therapy*; D018805:Sepsis / Q000175:diagnosis / Q000188:drug therapy*