INTRODUCTION: Encephalitis is a common infection of the brain, associated with a high risk of mortality and morbidity despite intensive supportive therapy. This report describes a patient with acute clinical meningoencephalitis who responded dramatically when her body temperature was decreased to normothermia (36 to 37 degrees C) in combination with barbiturate therapy. CASE PRESENTATION: A 15-year-old, previously healthy girl presented with a 2-day history of headache and meningeal stiffness and pyrexia. Cranial magnetic resonance imaging showed high-intensity signals in the splenium of the corpus callosum on T2-weighted and diffusion-weighted images. On day 4 of admission, the level of consciousness decreased and ataxic respiration and apnea appeared. After that, fever (body temperature >40 degrees C) developed with remarkable tachycardia. The body temperature was decreased with the use of a forced-air-cooling blanket and head cooling. The core temperature, measured in the bladder, was maintained at between 36 and 37 degrees C for 5 days. During the period of normothermia, thiopental sodium was given continuously for 3 days. After normothermia, the level of consciousness increased without the development of fever, and ventilatory support was withdrawn. CONCLUSION: Our experience suggests that normothermic treatment in combination with barbiturate therapy may be an effective option for the management of brain swelling associated with acute meningoencephalitis, particularly when accompanied by a persistent high fever.
INTRODUCTION:Encephalitis is a common infection of the brain, associated with a high risk of mortality and morbidity despite intensive supportive therapy. This report describes a patient with acute clinical meningoencephalitis who responded dramatically when her body temperature was decreased to normothermia (36 to 37 degrees C) in combination with barbiturate therapy. CASE PRESENTATION: A 15-year-old, previously healthy girl presented with a 2-day history of headache and meningeal stiffness and pyrexia. Cranial magnetic resonance imaging showed high-intensity signals in the splenium of the corpus callosum on T2-weighted and diffusion-weighted images. On day 4 of admission, the level of consciousness decreased and ataxic respiration and apnea appeared. After that, fever (body temperature >40 degrees C) developed with remarkable tachycardia. The body temperature was decreased with the use of a forced-air-cooling blanket and head cooling. The core temperature, measured in the bladder, was maintained at between 36 and 37 degrees C for 5 days. During the period of normothermia, thiopental sodium was given continuously for 3 days. After normothermia, the level of consciousness increased without the development of fever, and ventilatory support was withdrawn. CONCLUSION: Our experience suggests that normothermic treatment in combination with barbiturate therapy may be an effective option for the management of brain swelling associated with acute meningoencephalitis, particularly when accompanied by a persistent high fever.
Authors: M Munakata; R Kato; H Yokoyama; K Haginoya; Y Tanaka; J Kayaba; T Kato; R Takayanagi; H Endo; R Hasegawa; Y Ejima; K Hoshi; K Iinuma Journal: Brain Dev Date: 2000-09 Impact factor: 1.961
Authors: H Tada; J Takanashi; A J Barkovich; H Oba; M Maeda; H Tsukahara; M Suzuki; T Yamamoto; T Shimono; T Ichiyama; T Taoka; O Sohma; H Yoshikawa; Y Kohno Journal: Neurology Date: 2004-11-23 Impact factor: 9.910
Authors: S Kamei; T Sekizawa; H Shiota; T Mizutani; Y Itoyama; T Takasu; T Morishima; K Hirayanagi Journal: J Neurol Neurosurg Psychiatry Date: 2005-11 Impact factor: 10.154