Paroxysmal Autonomic Dysregulation with Fever that was Controlled by Propranolol in a Brain Neoplasm Patient
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Intractable fever in cancer patients is problematic and the causes of this fever can be diverse. Paroxysmal persistent hyperthermia after sudden mental change or neurologic deficit can develop via autonomic dysregulation without infection or any other causes of fever. Paroxysmal hyperthermic autonomic dysregulation is a rare disease entity. It manifests as a form of paroxysmal hypertension, fever, tachycardia, tachypnea, pupillary dilation, agitation and extensor posturing after traumatic brain injury, hydrocephalus, brain hemorrhage or brain neoplasm. We recently experienced a case of paroxysmal hyperthermia following intracerebral hemorrhage along with brain neoplasm. Extensive fever workups failed to show an infectious or inflammatory source and/or hormonal abnormality. Empirical treatments with antibiotics, antipyretics, morphine, steroid and antiepileptic agents were also ineffective. However, Propranolol, a lipophilic beta-blocker, successfully controlled the fever and stabilized the patient. Fever in cancer patients is a common phenomenon, but a central origin should be considered when the fever is intractable. Propranolol is one of the most effective drugs for treating paroxysmal hyperthermia that is due to autonomic dysregulation.
Abstract
Intractable fever in cancer patients is problematic and the causes of this fever can be diverse. Paroxysmal persistent hyperthermia after sudden mental change or neurologic deficit can develop via autonomic dysregulation without infection or any other causes of fever. Paroxysmal hyperthermic autonomic dysregulation is a rare disease entity. It manifests as a form of paroxysmal hypertension, fever, tachycardia, tachypnea, pupillary dilation, agitation and extensor posturing after traumatic brain injury, hydrocephalus, brain hemorrhage or brain neoplasm. We recently experienced a case of paroxysmal hyperthermia following intracerebral hemorrhage along with brain neoplasm. Extensive fever workups failed to show an infectious or inflammatory source and/or hormonal abnormality. Empirical treatments with antibiotics, antipyretics, morphine, steroid and antiepileptic agents were also ineffective. However, Propranolol, a lipophilic beta-blocker, successfully controlled the fever and stabilized the patient. Fever in cancer patients is a common phenomenon, but a central origin should be considered when the fever is intractable. Propranolol is one of the most effective drugs for treating paroxysmal hyperthermia that is due to autonomic dysregulation.
참고문헌 (19)
- "Incidence of fever in the rehabilitation phase following brain injury", 76, pp.323~327 (1997)
- "Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hyperthermia", 346, pp.557~563 (2002)
- "Importance of posttraumatic hypothermia and hyperthermia on the inflammatory response after fluid percussion brain injury: biochemical and immunocytochemical studies", 20, pp.531~542 (2000)
- "Paroxysmal sympathetic storms ("diencephalic seizures") after severe diffuse axonal head injury", 73, pp.148~152 (1998)
- "Increase in IL-6, IL-1 and TNF levels in rat brain following traumatic lesion", 42, pp.177~185 (1993)
- "Cyclooxygenase inhibition as a strategy to ameliorate brain injury", 19, pp.1~15 (2002)
- "Involvement of brain glutamate release in pyrogenic fever", 41, pp.811~818 (2001)
- "Nitric oxide metabolism in the cerebrospinal fluid of patients with severe head injury: inflammation as a possible cause of elevated NO metabolites", 56, pp.350~356 (2001)
- "Hyperthermia following traumatic brain injury: a critical evaluation", 12, pp.163~173 (2003)
- "Rehabilitation of traumatic brain injury", pp.1281~1299 (2000), Blackwell Science
- "Acute hypothalamic instability in traumatic brain injury", 82, pp.246~249 (2001)
- "Management of hyperthermia in traumatic brain injury", 8, pp.106~110 (2002)
- "The autonomic dysfunction syndrome: aetiology and treatment", the auto(mic dysfunction syndrome), pp.471~478 (1988)
- "Pyrexia in head-injured patients admitted to intensive care", 28, pp.1555~1562 (2002)
- "Fever of central origin in traumatic brain injury controlled with propranolol", pp.816~818 (1994)
- "Persistent autonomic hyperfunction following hypertensive intracerebral hemorrhage", 35, pp.636~638 (2004)
- "Bromocriptine for the management of autonomic dysfunction after severe traumatic brain injury", 36, pp.283~285 (2000)
- "Control of fever by continuous, low-dose diclofenac sodium infusion in acute cerebral damage patients", 26, pp.552~557 (2000)
- "Head injury and posttraumatic movement disorders", 50, pp.927~940 (2002)