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Central Hyperthermia

Fever or Hyperthermia. By definition:Fever: thermoregulation intact with increase set point of body temperatureHyperthermia: thermoregulation defect without change of set pointIn term, central hyperthermia may be more appropriate. Central Hyperthermia. Diagnostic criteria:A diagnosis by exclusion of other cause, such as infection..

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Central Hyperthermia

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    1. Central Hyperthermia Present: Ri ??? 2003/02/17

    2. Fever or Hyperthermia By definition: Fever: thermoregulation intact with increase set point of body temperature Hyperthermia: thermoregulation defect without change of set point In term, central hyperthermia may be more appropriate

    4. Central Hyperthermia Diagnostic criteria: A diagnosis by exclusion of other cause, such as infection.

    5. Central Hyperthermia Diagnostic fever protocol in traumatic brain injury patients: CBC with differential count, blood culture, CXR, and abdominal films. CT scan of head, culture invasion lines, Dupplex for DVT, drug fever, ABG, V/Q scan and drug fever.

    6. Central Hyperthermia Consider trial of broomocriptine and amantadine. If rapid resolution of autonomic signs, PTH was impressed.

    8. Central Hyperthermia Pathophysiology of central hyperthermia: Thermoregulator: rostral hypothalamic/ preoptic region Injury of other brain tissue release prostaglandin E2 However, NSAIDs doesn’t always have effect to central hyperthermia

    9. Central Hyperthermia Acute hydrocephalus and central hyperthermia: Hypothalamic compression to induce release of hypothalamic neuropeptide axonal stretch could inhibit the release of other agents, such as dopamine dopamine causes a fall in body temperature

    10. Central Hyperthermia Treatment: NSAIDs Bromocriptine Propranolol However, no definite effect can be proven in a large control-randomized trial.

    11. Central Autonomic Dysfunction Symptoms and signs (Frequency): Hyperthermia 25 % Diaphoresis 18 % Hypertension 26 % Tachypnea 18 % Rigidity 27 %

    12. Central Autonomic Dysfunction Clinical cause of central autonomic dysfunction: Cerebral anoxia Cerebral venous sinus thrombosis Subacute hydrocephalus Intracranial brain tumor Trauma

    13. Central Autonomic Dysfunction The symptoms of CAD often lasts several hours with one episode. Recurrence of symptoms generally occur for weeks after injury. Is elevated body temperature controlled by NSAIDs? No definite answer.

    14. Central Autonomic Dysfunction Most patients had two to three symptoms of cerebral autonomic dysfunction. CAD occurred less common in traumatic injuries than anoxic injuries. Onset of CAD is almost within one week. Occurrence of CAD is associated with poor prognosis.

    15. Central Hyperthermia The etiology, mechanisms and treatment for PTH are complex and not well understood.

    16. Reference 1. Central Autonomic Dysfunction Following Acquired Brain Injury in Children- J Neuro Rehab, Vol 7, No. 1 c 1997 2. Hyperthermia. N Engl J Med 1993; 329(7): 483-87 3. Post traumatic hyperthermia in acute brain injury rehabilitation. Brain Inj 1994; 8(4): 335-43 4. Fever of central origin in traumatic brain injury controlled by propranolol. Arch Phys Med Rehabili 1994; 75: 816-19

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