Central Fever

Central fever / Paroxysmal Hyperthermic Autonomic Dysregulation

  • commonly associated with closed head injury, hydrocephalus
  • nonsustained episodes of hyperpyrexia, tachycardia , tachypnea, increased blood pressure, increased extensor tone, pupil dilatation, diaphoresis (see related post on sympathetic storming)

Pathophysiology:

  • injury involving hypothalamus
  • neuroimmulogic mechanisms?
  • initial release of cytokines (IL-1, IL-6, TNF-α and IFN-γ), secondary to direct trauma, infection of brain, inflammatory stimulation and increased ICP after acute brian injury activate COX-2 pathways in periventricular cells and production of PGE
  • stressed cells after brain injury synthesize heath shock proteins in coordinated response to tissue injury
  • glutamate and nitric oxide release caused by autonomic dysregulation of the brianstem

Rule out:

  • infection
  • epileptic disorders
  • pheochromocytoma
  • NMS
  • increased ICP
  • hydrocephalus
  • Cushing’s syndrome
  • thyrotoxicosis
  • DVT

Treatment:

  • The current effective drugs are
    • propranolol, opioid, clonidine, bromocriptine, chlorpromazine, dantrolene  
    • Propranolol 20 to 30 mg every 6 hours
  • Stereotactic surgery is sometimes considered when these drugs are ineffective

 

Reference:

Meythaler, J., & Stinson, A. (1994). Fever of central origin in traumatic brain injury controlled with propranolol. Archives Of Physical Medicine And Rehabilitation75(7), 816-818. doi: 10.1016/0003-9993(94)90143-0

Oh, S., Hong, Y., & Song, E. (2007). Paroxysmal Autonomic Dysregulation with Fever that was Controlled by Propranolol in a Brain Neoplasm Patient. The Korean Journal Of Internal Medicine22(1), 51. doi: 10.3904/kjim.2007.22.1.51

 

 

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