Central Hyperthermia Treated with Bromocriptine

P Natteru, P George, R Bell, P Nattanmai, C R Newey, P Natteru, P George, R Bell, P Nattanmai, C R Newey

Abstract

Introduction. Central hyperthermia is common in patients with brain injury. It typically has a rapid onset with high temperatures and marked fluctuations and responds poorly to antibiotics and antipyretics. It is also associated with worse outcomes in the brain injured patient. Recognizing this, it is important to aggressively manage it. Case Report. We report a 34-year-old male with a right thalamic hemorrhage extending to the midbrain and into the ventricles. During his admission, he developed intractable fevers with core temperatures as high as 39.3°C. Infectious workup was unremarkable. The fever persisted despite empiric antibiotics, antipyretics, and cooling wraps. Bromocriptine was started resulting in control of the central hyperthermia. The fever spikes were reduced to minor fluctuations that significantly worsened with any attempt to wean off the bromocriptine. Conclusion. Diagnosing and managing central hyperthermia can be challenging. The use of bromocriptine can be beneficial as we have reported.

Conflict of interest statement

The authors have no conflict of interests to report.

Figures

Figure 1
Figure 1
Computed tomography (CT) of the head. (a) CT head on admission showing a right thalamic hemorrhage with intraventricular extension. Note the obstructive hydrocephalus. (b) CT head on hospital day 9 showing evolution of the right thalamic hemorrhage and resolution of the obstructive hydrocephalus with external ventricular drainage (not shown) and after intraventricular tissue plasminogen activator (tPA).
Figure 2
Figure 2
Temperature graph. Average core temperature for each day during hospital course is graphically shown. Error bars are standard errors of the mean. Bromocriptine was started on days 2, 13, and 22. It was stopped on days 6 and 21. Immediately after discontinuation of bromocriptine, there was a significant increase in core temperature. After resuming bromocriptine, there was a significant decrease in core temperature. ∗p < 0.05, ∗∗p < 0.001, and ∗∗∗p < 0.0001.

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