Presentation
Here, we present an exceptional case affected by this syndrome. Its singularity is 2-fold. On one hand, the patient presented periodic episodes of dyskinesia-hyperpyrexia during 3 consecutive summers. [ncbi.nlm.nih.gov]
Entire Body System
- Fever
See also fever. hyperpyretic, adj. hy·per·py·rex·i·a ( hī'pĕr-pī-rek'sē-ă ) Extremely high fever. [ hyper- + G. pyrexis, feverishness] hyperpyrexia Body temperature above 41.1 C (106 F). [medical-dictionary.thefreedictionary.com]
– Seen in malaria, Borrelia infections, rat-bite fever, and lymphoma (Pel Ebstein fevers) – Remittent fever: temperature falls daily but does not return to normal – Seen in TB and viral diseases – Intermittent fevers: exaggerated circadian rhythm – Seen [slideshare.net]
The pathophysiology, clinical features, and management of this uncommon cause of fever are discussed. [ncbi.nlm.nih.gov]
- Malaise
[…] zmogljivost, bolečine v prsih, gripi podobna bolezen, slabo počutje, letargija, hiperpireksija English Common: Peripheral oedema, mucosal inflammation, pain, rigors, oedema, weakness, decreased performance status, chest pain, influenza-like illness, malaise [mymemory.translated.net]
Signs and Symptoms • Chills, shivering, and rigors – Mechanisms to raise body core temperature • Fatigue • Malaise • Myalgias • Night sweats • Anorexia 8. • Specific fever patterns – Relapsing fevers: febrile episode with alternating afebrile intervals [slideshare.net]
) · throat ( R07.0 ) · tongue ( K14.6 ) · tooth ( K08.8 ) renal colic ( N23 ) R52.0 Acute pain R52.1 Chronic intractable pain R52.2 Other chronic pain R52.9 Pain, unspecified Generalized pain NOS R53 Malaise and fatigue Asthenia NOS Debility: · NOS [apps.who.int]
Cardiovascular
- Hypotension
Autonomic dysfunction includes urinary retention, constipation, and orthostatic hypotension. All are treated with usual measures, but persistent or severe orthostatic hypotension may require further treatment with volume expanders or vasopressors. [emdocs.net]
Hyponatremia and other electrolyte disturbances are also quite common, as is hypotension, hyperpyrexia or, late in the disease, hypothermia. "It's called hyperpyrexia ," Laurie said, staring at Stuart Morgan. [diki.pl]
[…] en Symptomatic hypotension Substantial decrease in blood pressure and hence symptomatic hypotension can occur in patients with volume and/or sodium depletion resulting from diuretic therapy, fluid loss of other origin such as excessive diaphoresis, prolonged [sl.glosbe.com]
He had postural hypotension and nitrite positive urine dip. The labile blood pressure was attributed to his multiple anti-parkinsonian medications (4 mg ropinirole daily, 100/25 mg co-careldopa 5 times a day and 10 mg selagiline daily). [ejinme.com]
- Pulmonary edema, oliguria, hypotension, rigidity, apnea, pulselessness, areflexia, unresponsiveness, fixed pupils, and decreased or absent activity on EEG 12. [slideshare.net]
- Orthostatic Hypotension
Autonomic dysfunction includes urinary retention, constipation, and orthostatic hypotension. All are treated with usual measures, but persistent or severe orthostatic hypotension may require further treatment with volume expanders or vasopressors. [emdocs.net]
hypotension ( I95.1 ) neurogenic orthostatic hypotension ( G90.3 ) shock: · NOS ( R57.9 ) · cardiogenic ( R57.0 ) · complicating or following: · abortion or ectopic or molar pregnancy ( O00-O07, O08.3 ) · labour and delivery ( O75.1 ) · postoperative [apps.who.int]
Skin
- Hot, Dry Skin
Typically, patients suffering from hyperthermia have hot, dry skin. Patients who have infection might be warm or moist or sweaty. [medscape.com]
If the condition progresses to heat stroke, then hot, dry skin is typical[8] as blood vessels dilate in an attempt to increase heat loss. An inability to cool the body through perspiration may cause the skin to feel dry. [en.wikipedia.org]
Psychiatrical
- Visual Hallucination
He was disoriented and responding to visual hallucinations. Investigations revealed an elevated creatine kinase and a provisional diagnosis of PHS was made. [ncbi.nlm.nih.gov]
Other signs of overdose may include: confusion, disturbed concentration, transient visual hallucinations, dilated pupils, agitation, hyperactive reflexes, stupor, drowsiness, muscle rigidity, vomiting, hypothermia, hyperpyrexia. [diki.pl]
[…] en These include paranoid psychosis, tachycardia, hypertension, diaphoresis, breathing problems, severe agitation, auditory and visual hallucinations, profound anxiety, hyperthermia, violent outbursts and multiple organ dysfunctions. sl Ne vem kakšno [sl.glosbe.com]
Four days post admission the patient was found in a ‘confused, rigid and hallucinating’ state with a temperature of 40.2 °C. He had increased tremor and stiffness, profuse sweating, tachypnoea, tachycardia and visual hallucinations. [ejinme.com]
Family members brought the patient to the emergency department due to a 6-day history of fever (reaching 39°C), sleepiness, disorientation in time and space, visual hallucinations, increased limb rigidity, and increased tremor and bradykinesia, which [elsevier.es]
Neurologic
- Confusion
We observed a patient who, during the administration of intravenous cimetidine, became hyperpyretic and confused. Six hours after cimetidine therapy was discontinued, he became afebrile. [ncbi.nlm.nih.gov]
Her mental status was alert without confusion at the time of arrival, but after several hours, her dyskinesia grew worse and she became confused. Body temperature was 39.2°C. Her blood test showed mild leukocytosis (WBC 10,090/mm3). [e-jmd.org]
[…] occur: extreme confusion loss of consciousness rapid, shallow breathing dry, hot, and red skin weak, fast pulse widened pupils seizures It is essential to seek treatment for fevers over 106.1°F to help prevent serious long-term complications or death [medicalnewstoday.com]
- Dizziness
[…] experience an allergic reaction to carboplatin injection, it may begin within a few minutes after your infusion starts, and you may experience the following symptoms: hives; skin rash; itching; reddening of the skin; difficulty breathing or swallowing; dizziness [fi.health-root.com]
Early symptoms may include: increased thirst extreme sweating dizziness muscle cramps fatigue and weakness nausea light-headedness As the high temperature persists or gets worse, the severity of the symptoms can increase. [medicalnewstoday.com]
- Altered Mental Status
Treatment • Monitoring and IV access should be obtained in the field for unstable patients or patients with altered mental status • Immediate treatment rarely required • Airway control, breathing and circulatory support for unstable patients • Initiate [slideshare.net]
[…] en Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis and cardiac dysrhythmia sl Torej živi v Chicagu ali največ # [sl.glosbe.com]
English Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis and cardiac dysrhythmia). [mymemory.translated.net]
- Agitation
At the end of surgery, following extubation he developed agitation, intense shivering and hyperpyrexia, and his level of consciousness decreased to a Glasgow Coma score of 7. [ncbi.nlm.nih.gov]
Other signs of overdose may include: confusion, disturbed concentration, transient visual hallucinations, dilated pupils, agitation, hyperactive reflexes, stupor, drowsiness, muscle rigidity, vomiting, hypothermia, hyperpyrexia. [diki.pl]
convulsions or seizures, confusion and aggression. en These include paranoid psychosis, tachycardia, hypertension, diaphoresis, breathing problems, severe agitation, auditory and visual hallucinations, profound anxiety, hyperthermia, violent outbursts [sl.glosbe.com]
Patients may be confused, agitated or anxious. Findings of generalized hyperreflexia and sustained clonus are very suggestive of serotonin toxicity. [calpoison.org]
The person is treated with intravenous fluids in order to rehydrate fairly slowly, often sedation is required as the victim can become very agitated, in some cases, a bear hugger will be required. [overheating-heat-stroke.knoji.com]
- Stupor
The Neuropsychiatric Guide to Modern Everyday Psychiatry Stuporous patients are unable to eat or drink and, if untreated,, can develop severe dehydration, hemoconcentration, hyperpyrexia, ketosis, and eventually cardiovascular collapse and death. [wordnik.com]
Diagnosis Code T67.0 Heatstroke and sunstroke 2016 2017 2018 2019 Non-Billable/Non-Specific Code Applicable To Heat apoplexy Heat pyrexia Siriasis Thermoplegia Use Additional code(s) to identify any associated complications of heatstroke, such as: coma and stupor [icd10data.com]
Other signs of overdose may include: confusion, disturbed concentration, transient visual hallucinations, dilated pupils, agitation, hyperactive reflexes, stupor, drowsiness, muscle rigidity, vomiting, hypothermia, hyperpyrexia. [diki.pl]
The level of consciousness fluctuates and ranges from an alert mutism to stupor or coma. Signs of autonomic dysfunction include pallor, tachycardia, labile blood pressure, profuse diaphoresis, and urinary incontinence. [medtextfree.wordpress.com]
Workup
Psychosis can result from disease progression, medication side-effects, or an underlying illness. 6 The workup is similar to most patients with a new presentation of psychosis: a complete medication history, a search for occult causes and infections such [emdocs.net]
She was administered 2 liters of normal saline and a workup for possible infection ensued. Her sister later arrived and stated that her paroxetine dose was doubled from 20 to 40 mg last week and that she may have taken a few extra pills. [calpoison.org]
Treatment
After the patient failed to respond during a 2-week period to supportive measures, electroconvulsive therapy (ECT) treatment was commenced. [ncbi.nlm.nih.gov]
[…] get better after treatment has finished. [fi.health-root.com]
Treatment • Monitoring and IV access should be obtained in the field for unstable patients or patients with altered mental status • Immediate treatment rarely required • Airway control, breathing and circulatory support for unstable patients • Initiate [slideshare.net]
Prognosis
The prognosis is improved with early recognition and management. Mortality of up to 4% has been reported, but an additional one-third of patients have permanent sequelae. [ncbi.nlm.nih.gov]
Prognosis Currently associated with a less than 10% mortality rate, and getting significantly better. [medrevise.co.uk]
"Febrile seizures: risks, evaluation, and prognosis". American Family Physician. 85 (2): 149–53. PMID 22335215. ^ a b Gupta, A (February 2016). "Febrile Seizures". [en.wikipedia.org]
[…] malignant catatonia,11 and dyskinesia-hyperpyrexia syndrome.12 The most common complications of PHS are respiratory insufficiency, sepsis, seizures, disseminated intravascular coagulation, and renal insufficiency; the latter 2 complications indicate poor prognosis [elsevier.es]
Anterior horn cell degeneration in the spinal cord adds to the morbidity and has adverse prognosis. Acknowledgment My sincere thanks to the Head of Department, faculty members, colleagues and my family for their immense support. [annalsofian.org]
Etiology
Negative blood, cerebrospinal fluid, and stool cultures excluded bacterial sepsis as a possible etiology. [ncbi.nlm.nih.gov]
Etiology • infectious process • Drugs – Antiarrhythmics (procainamide, quinidine) – Antibiotics (penicillins, sulfonamides, erythromycin, isoniazid, nitrofurantoin) – Anticonvulsants (barbiturates, carbamazepine, phenytoin) – Antidepressants (TCAs, monoamine [slideshare.net]
A wide range of etiologies have been identified in the literature for an insidious onset of hyperpryexia, however a rapid ascent higher than temperatures of 106.7°F has never been reported nor evaluated. [jem-journal.com]
Sioson and colleagues[3] examined adults and found (although this dates from many years ago) 39 adults with hyperpyrexia, and 94% of that group had an infectious etiology: bacterial, fungal, or viral. [medscape.com]
Epidemiology
Epidemiology Pretty rare - about 1 in 10,000 operations will result in one of these. Pathophysiology It is an inherited autosomnal dominant condition. [medrevise.co.uk]
Epidemiology The incidence of MH is low, but the prevalence can be estimated as up to 1:3,000. [ 1 ] It is inherited as an autosomal dominant gene of variable penetrance. [ 6 ] As may be expected with any familial condition, there are geographical clusters [patient.info]
Google Scholar | Crossref | Medline | ISI Dagan R., Hall CB, Powell KR, Menegus MA Epidemiology and laboratory diagnosis of infection with viral and bacterial pathogens in infants hospitalized for suspected sepsis. J Pediatr. 1989;115: 351-356. [journals.sagepub.com]
"Relation between Elevated Ambient Temperature and Mortality: A Review of the Epidemiologic Evidence". Epidemiologic Reviews. 24 (2): 190–202. doi:10.1093/epirev/mxf007. ISSN 0193-936X. PMID 12762092. ^ Gover, Mary (1938). [en.wikipedia.org]
Temporal trends in the epidemiology of severe postoperative sepsis after elective surgery: a large, nationwide sample. Anesthesiology 2010 ; 112 : 917 – 925. 51. Berry, F., Blankenbaker, W., Ball, C.. [cambridge.org]
Pathophysiology
The pathophysiology, clinical features, and management of this uncommon cause of fever are discussed. [ncbi.nlm.nih.gov]
Pathophysiology It is an inherited autosomnal dominant condition. [medrevise.co.uk]
Fever is driven by different pathophysiology. Typically, patients suffering from hyperthermia have hot, dry skin. Patients who have infection might be warm or moist or sweaty. [medscape.com]
Effective strategies to prevent and treat AD remain elusive despite major efforts to understand its basic biology and clinical pathophysiology. Significant investments in therapeutic ... [annualreviews.org]
Other agents such as desflurane, sevoflurane, and isoflurane can cause florid malignant hyperthermia (MH) reactions in the same way as halothane but are also associated with reactions with the onset delayed for several hours into anaesthesia. [ 3 ] Pathophysiology [patient.info]
Prevention
If the patient shows unexplained changes in consciousness with hyperpyrexia after surgery, PHS should be considered and adequate treatment should be given immediately to prevent death. [ncbi.nlm.nih.gov]
In rats subjected to acute cold stress, asarone prevented the depletion of adrenal ascorbic acid showing thereby that it is an agent specific in counteracting stress. [jpet.aspetjournals.org]
It has been recommended for the treatment and prevention of PPH by ACOG, FIGO and WHO [ 9, 10, 11 ]. [bmcresnotes.biomedcentral.com]
Though STN–DBS might prevent PHS, fatal PHS can occur when the PD medications are reduced even when patients are under continuous STN stimulation [ 2 ]. [omicsonline.org]