Intractable Central Hyperthermia in the Setting of Brainstem Hemorrhage

Samudra, Niyatee; Figueroa, Stephen A.

doi:10.1089/ther.2016.0004

Cited by 8 publications

(7 citation statements)

References 18 publications

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“…This reason had led us to postulate that extra body heat necessary for the rewarming process was provided by her later found brain stem hemorrhage. The mechanism of central hyperthermia is still incompletely understood though it is thought to be originated from miscommunications of the spinothalamocortical pathways leading to persistent thermogenic signals [ 10 ]. For our patient, this thermogenic process could have reversed the original hypothermia.…”

Section: Discussionmentioning

confidence: 99%

When a Dead Patient Is Not Really Dead: Lazarus Phenomenon

Sharma¹,

Chandna

Nguyen³

et al. 2020

Case Reports in Critical Care

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Lazarus phenomenon refers to autoresuscitation of a patient declared dead after cessation of cardiopulmonary resuscitation (CPR). The Lazarus phenomenon is rarely encountered and pathophysiology is not very well understood, but physicians need to be aware of this phenomenon. It is prudent that a physician leading a CPR effort waits for some time and monitors the patient further using blood pressure and electrocardiogram before confirming that a patient is actually dead.

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Section: Discussionmentioning

confidence: 99%

When a Dead Patient Is Not Really Dead: Lazarus Phenomenon

Sharma¹,

Chandna

Nguyen³

et al. 2020

Case Reports in Critical Care

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“…Deogaonkar (2005) illustrated that, the severity of fever caused by massive volume intracerebral hematoma is attributed to direct compression of brainstem and hypothalamic thermoregulatory centers. Wijdicks and St Louis (1997), in a retrospective study correlated mortality rate in patients associated with low GCS < 8, absent brainstem reflex like oculocephalic reflex or poor motor response in brainstem hemorrhage [2].…”

Section: Discussionmentioning

confidence: 99%

Traumatic “brain stem contusion” (BSC): Acute presentation and management in a tertiary medical centre- A case report and review of literature

Swarnakar¹,

Tripathy²,

Dhir³

et al. 2018

J Neurosci Neurosurg

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Traumatic Brain Injury (TBI) constitutes a wide spectrum of clinic-radiological events, ranging from EDH (Extra dural hematoma), ASDH (Acute Subdural Hematoma), contusion or DAI (Diffuse Axonal Injury). TBI present to Emergency Department (ED) either due to RTA (Road Traffic Accident), an assault or a fall from height. They result in closed type or open type of head injury. Brain stem is the part of brain more over injured by severe collisional impact to the skull causing alteration in microstructural organization inside the brain. Patients usually present with altered sensorium. The impact of trauma may be either localized or distributed all over. Here we present an uncommon case of traumatic "Brain Stem Contusion" (BSC), its presentation & management in an acute setting. Case Description Here we present a case of a 35 year male (Figure 1b) presenting to our E.D. (Emergency department) with altered sensorium, vomiting, bleeding from nose and two episode of convulsions, due to fall from bike under the influence of alcohol, with Glasgow coma scale (GCS)-E1V1M5 (7/15). There was left sided hemiparesis (MRC-Medical research council, Grade-2/5). Pulse rate was 62 per min, blood pressure 140/80 mm of Hg. Respiration was abdominothoracic type, 18 per minute; left pupil dilated but sluggishly reacting to light, right side normally reacting to light. There was right side weakness (Figure 1a) of both the limbs. Noncontrast CT scan of the brain revealed brain stem contusion (BSC), in the midbrain area on the right side with DAI (Figure 2).

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“…Bromocriptine group [25] received bromocriptine 7.5 mg/day during 24 hours from admission through a naso-gastric (NG) feeding tube, then changed to oral route after good swallowing and gag reflex were ensured. Bromocriptine was held if patient developed any contraindication to it.…”

Section: Methodsmentioning

confidence: 99%

“…There is an increasing evidence showing that central fever is associated with poor response to traditional antipyretics [24]. So, it may require a multimodal approach of management with new medications as Bromocriptine and/or surface or intravascular cooling device [25]. In this study, we tried to evaluate the role of Bromocriptine in central hyperthermia in patients with severe TBI.…”

Section: Introductionmentioning

confidence: 99%

Bromocriptine in Central Hyperthermia after Severe Traumatic Brain Injury

Zakhary¹,

Sabry²

2017

OJEM

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Strong evidence showed that fever after traumatic brain injury TBI is associated with increased mortality. In this study, we tried to evaluate the role of Bromocriptine in central hyperthermia in patients with severe TBI. This prospective controlled study was conducted on 50 severe TBI patients who admitted to the critical care department and confirmed on Computed Tomography (CT) of the brain and GCS of less than 9 at admission. Then, they were randomly assigned into 2 groups. Bromocriptine group (25) received bromocriptine 7.5 mg/day during 24 hours from admission through a naso-gastric (NG) feeding tube. Control group (25) received conventional treatment only. Temperature was measured every 2 hours. The antipyretic measures used were the same across all patients enrolled. The primary outcome was number of patients diagnosed with central hyperthermia. After the discharge of all patients, there was a statistically significant difference between the 2 groups in number of patients diagnosed with central hyperthermia (6 (24%) in bromocriptine group Vs 18 (72%) in control, p = 0.002). There were no differences in hospital length of stay (p = 0.904) or mortality (p = 0.393). Early administration of bromocriptine in severe TBI may be associated with lower incidence of central hyperthermia with no effect on length of stay or mortality.

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Intractable Central Hyperthermia in the Setting of Brainstem Hemorrhage

Cited by 8 publications

References 18 publications

When a Dead Patient Is Not Really Dead: Lazarus Phenomenon

When a Dead Patient Is Not Really Dead: Lazarus Phenomenon

Traumatic “brain stem contusion” (BSC): Acute presentation and management in a tertiary medical centre- A case report and review of literature

Bromocriptine in Central Hyperthermia after Severe Traumatic Brain Injury

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