Effectively managing intractable central hyperthermia in a stroke patient by bromocriptine: a case report

Abstract

Central hyperthermia is characterized by a rapid onset, high temperature, marked temperature fluctuation, and poor response to antipyretics and antibiotics. Although poststroke central hyperthermia is common, prolonged instances are rare. We report a case of prolonged central fever after an intracranial hemorrhage. Before the accurate diagnosis and management of central fever, the patient underwent long-term antibiotic use that led to pseudomembranous colitis. Bromocriptine was used to treat the prolonged central hyperthermia, after which the fever did not exceed 39°C. A week later, the body temperature baseline was reduced to 37°C and a low-grade fever with minor temperature fluctuation occurred only a few times. No fever occurred in the month following the treatment. After the fever subsided, the patient could undergo an aggressive rehabilitation program.

Keywords: bromocriptine; central hyperthermia; fever; stroke.

Figure 1

CT findings of the brain. (A) Left cerebellar hemorrhage and brainstem hemorrhage with IVH shown in the preoperational CT. (B) Encephalomalacia change in the left cerebellum and midbrain (30 days after the emergent operation). Abbreviations: CT, computed tomography; IVH, intraventricular hemorrhage.

Figure 2

High fever with marked temperature fluctuation was noted during the clinical course. Notes: Blood pressure, heart rate, and respiratory rate were within the normal range. The body temperature stabilized after the administration of bromocriptine.