Bromocriptine for control of hyperthermia in a patient with mixed autonomic hyperactivity after neurosurgery: a case report

Abstract

Mixed autonomic hyperactivity disorder (MAHD) among patients with acquired brain injury can be rare. A delayed diagnosis of MAHD might exacerbate the clinical outcome and increase healthcare expenses with unnecessary testing. However, MAHD is still an underrecognized and evolving disease entity. A 25-yr-old woman was admitted the clinic due to craniopharyngioma. After an extensive tumor resection, she complained of sustained fever, papillary contraction, hiccup, lacrimation, and sighing. An extensive evaluation of the sustained fever was conducted. Finally, the cause for MAHD was suspected, and the patient was successfully treated with bromocriptine for a month.

Keywords: Autonomic Dysfunction; Bromocriptine; Central Fever; Neurosurgery; Suprasellar Tumor.

Fig. 1

Magnetic resonance imaging (MRI) findings of the brain. (A) The MRI on admission shows a heterogeneously enhancing, partially calcified mass in the suprasellar region with obstructive hydrocephalus and hematoma fluid level. (B) The post-operative follow-up MRI taken on the 21st day after craniotomy shows no residual solid tumor but multiple, small, intracranial hemorrhages, in the frontal and the right thalamus.

Fig. 2

Computed tomography (CT) findings of the brain. (A) Suprasellar mixed density and hydrocephalus were showed in the pre-operational CT. (B) Hydrocephalus decreased and intra-ventricular hemorrhage was revealed in the post-operation CT. (C) Subdural effusion over the left frontal convexity was demonstrated, but there were no residual tumors or infection foci.

Fig. 3

The graph illustrates the occurrence of hyperthermia in post-operative days, while blood pressure and heart and respiratory rates were within normal limits. Note that fever lysis was seen on the third day after starting bromocriptine treatment.