Introduction
Central thermoregulation dysfunction is a very rare symptom that may occur after subarachnoid hemorrhage, brain damage, and stroke. If the temperature is higher than 41 ° C, or if there is fever more than 39 ° C within 6 hours after stroke, or if there is severe fluctuation within 1 month, the mortality rate is 70%. Therefore, early diagnosis and treatment of central hyperthermia are important after brain damage, and are discussed in a few case reports. However, there are no reports of patients with central thermoregulation dysfunction persisted until the sub-acute phase. In this case report, we report the pattern and treatment of central hyperthermia in a patient with sub-acute phase after pontine hemorrhage.
Case Report
A 37-year-old man was hospitalized with acute pontine hemorrhage. The size of hemorrhage was 3.8x1.5x2.0cm in brain computed tomography (CT) and he took the non-surgical treatment (figure 1). The fever developed on the day of the cerebral hemorrhage and prolonged despite of the termination of treatment for the infectious disease. Two months after pontine hemorrhage, he was hospitalized again with a recurrent intermittent fever over 38°C. Body temperature changed from 36.3 to 40.3°C. He had alert consciousness at normal body temperature but showed drowsiness at high temperature. Initial evaluation was performed two months after hemorrhage and his Korean version of Mini-Mental State Exam (K-MMSE) was zero. All infectious diseases were excluded and diagnosed as central thermoregulation dysfunction. The over 38.3 degrees of body temperature persisted despite taking the medication as follows; acetaminophen 3600 mg, naproxen 1000 mg, baclofen 60 mg. So, bromocriptine 5 mg was added and after 3 days the dose was increased to 10 mg. After adding bromocriptine, the body temperature was maintained within the normal range, and baclofen was reduced to 10 mg over 10 days. Hyperthermia again occurred and baclofen was increased to 20 mg. Thereafter, his body temperature remained normal range and he was able to participate in rehabilitation program. His K-MMSE score was improved to 13/30, and simple communication was possible.
Discussion
It is known that high fever is highly likely to cause neurological deficits and deterioration of cognitive function. In this case, the patient’s participation in rehabilitation program was limited due to low consciousness accompanied with high fever and after control of thermoregulation, his neurological recovery could be expected. The possibility of central thermoregulation dysfunction should be considered in patients with recurrent hyperthermia also in the sub-acute phase after stroke, and the treatment may have an impact on prognosis. |
