1/3. Intrathecal baclofen withdrawal mimicking sepsis.baclofen (Lioresal) is a drug of choice to treat spasticity and is increasingly being administered intrathecally via an implantable pump in cases refractory to oral therapy. Emergency physicians will likely treat patients with baclofen withdrawal or overdose as this treatment becomes more widespread. The syndrome of baclofen withdrawal presents with altered mental status, fever, tachycardia, hypertension or hypotension, seizures, and rebound spasticity, and may be fatal if not treated appropriately. baclofen withdrawal may mimic other diseases including sepsis, meningitis, autonomic dysreflexia, malignant hyperthermia, or neuroleptic malignant syndrome. Treatment consists of supportive care, reinstitution of baclofen, benzodiazepines, and diagnosis and eventual repair of intrathecal pump and catheter malfunction.- - - - - - - - - - ranking = 1keywords = hyperthermia (Clic here for more details about this article) |
2/3. Hypothalamic-midbrain dysregulation syndrome: hypertension, hyperthermia, hyperventilation, and decerebration.Certain decerebrate lesions of brain stem or hypothalamus induce pharmacologically reversible hypertension and hyperthermia in animals. We observed three young patients with episodic decerebration, hyperthermia, hypertension, and hyperventilation during recovery from comas of different etiologies. The shared pathology on neurologic examinations and computed tomographic scans was hypothalamic-mesencephalic dysfunction, suggesting a diencephalic-brain-stem disconnection syndrome or brain-stem release mechanism. propranolol was the most effective drug tested, but only two patients responded, one dramatically. This novel clinical syndrome may have localizing and therapeutic significance in pediatric coma that needs to be further defined in future studies.- - - - - - - - - - ranking = 6keywords = hyperthermia (Clic here for more details about this article) |
3/3. Characteristic oscillations of intracranial pressure after delayed lowering of blood pressure in patient with shearing injury.A comatose patient with severe shearing injury showed hyperthermia, leucocytosis and decerebration. Rapid disappearance of brain swelling as well as a transient fall of blood pressure were peculiar in his clinical course. Large pressure waves appeared more frequently after such attacks. The authors concluded that cerebral vasomotor instability was caused by a primary lesion throughout an area from the anterior hypothalamus to the upper brain stem. Pre-existing hypoxia in such primary lesions was augmented by hypotensive episodes. Frequent appearance of large pressure waves was thought to represent progressive vascular engorgement followed by an uncontrollable increase of the ICP.- - - - - - - - - - ranking = 1keywords = hyperthermia (Clic here for more details about this article) |