Parkinsonism-Hyperpyrexia Syndrome: A Case Series and Literature Review

Azar, Jehad; Jaber, Yasmin; Ayyad, Mohammed; alia, Walaa Abu; Owda, Fahed; Sharabati, Haneen; Zeid, Hiba; Khreshi, Suleiman; AlBandak, Maram; Ahmad, Dana Sayyed

doi:10.7759/cureus.29646

Cited by 3 publications

(4 citation statements)

References 31 publications

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“… 15 , 16 , 17 Similar presentations were also reported following the withdrawal or malfunction of deep brain stimulation devices. 3 , 7 Reintroducing the medications and providing supportive care led to improvements in the clinical condition within 15 hours to 2 weeks in most reported cases, consistent with our patient’s recovery. However, the mortality rate of PHS has been reported to be 4% when treated and may reach up to 20% when untreated.…”

Section: Discussionsupporting

confidence: 82%

“…Understanding the clinical context in which these features occur is essential for diagnosing properly. 7 In this case, the patient developed pleural effusion, which might be a possible cause of the desaturation. However, it doesn’t explain the constellation of features described, particularly the neurological features.…”

Section: Discussionmentioning

confidence: 79%

“…Our patient had only one episode of fever, in contrast to multiple reported cases where patients had more severe fever. 3 , 7 …”

Section: Discussionmentioning

confidence: 99%

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Parkinsonism-Hyperpyrexia Syndrome in a patient undergoing upper gastrointestinal surgery: A case report

Shaikh,

Saadeddin

2024

Qatar Medical Journal

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Background: Parkinsonism-hyperpyrexia syndrome (PHS) is a potentially life-threatening condition that occurs due to the abrupt withdrawal or significant dose reduction of antiparkinsonian medications. It presents similarly to neuroleptic malignant syndrome (NMS) and is characterized by severe rigidity, fever, autonomic instability, and altered mental status. Case: A 62-year-old male with a 10-year history of Parkinson’s disease (PD) underwent laparoscopic mesh repair for a left-sided diaphragmatic and large hiatus hernia. His antiparkinsonian medications included levodopa/carbidopa, amantadine, pramipexole, and benzhexol. Medications were withheld as part of the nil per os (NPO) status. Postoperatively, he developed withdrawal features, including tremors, difficulty speaking, tachycardia, hypertension, fever, and sweating. PHS, resulting from the withdrawal of antiparkinsonian medications, was diagnosed. The patient was transferred to the intensive care unit (ICU), intubated, and his antiparkinsonian medications were reintroduced. The patient’s condition improved gradually, and he was discharged home on the 15th postoperative day. Discussion: The abrupt discontinuation of antiparkinsonian medications precipitated PHS in our patient. Recognizing the clinical picture of PHS and differentiating it from other possible conditions, such as neuroleptic malignant syndrome and malignant hyperthermia, is pivotal. Management involves resuming medications and providing supportive care. Early recognition and prompt reintroduction of the antiparkinsonian medications are essential for the patient’s recovery. Conclusion: PHS is a rare but potentially life-threatening condition that occurs due to the withdrawal of antiparkinsonian medications, leading to an acute hypodopaminergic state. Our case emphasizes the importance of careful perioperative management of antiparkinsonian medications and early recognition and management of withdrawal symptoms in patients with Parkinson’s disease undergoing surgery.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 79%

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Parkinsonism-Hyperpyrexia Syndrome in a patient undergoing upper gastrointestinal surgery: A case report

Shaikh,

Saadeddin

2024

Qatar Medical Journal

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“…[34] Hyperpyrexia-neurological syndrome, including Parkinson's hyperpyrexia syndrome, neuro-blocker malignant syndrome, and 5-hydroxytryptamine syndrome, often manifests as high fever, fatigue, sweating, and altered mental status, among other symptoms. [45][46][47][48] This type of disorder can be identified based on specific medical and medication histories.…”

Section: Diagnosismentioning

confidence: 99%

Chlorfenapyr poisoning: mechanisms, clinical presentations, and treatment strategies

Cheng,

Chen,

Wang

et al. 2024

World Journal of Emergency Medicine

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BACKGROUND: Chlorfenapyr is used to kill insects that are resistant to organophosphorus insecticides. Chlorfenapyr poisoning has a high mortality rate and is difficult to treat. This article aims to review the mechanisms, clinical presentations, and treatment strategies for chlorfenapyr poisoning. DATA RESOURCES:We conducted a review of the literature using PubMed, Web of Science, and SpringerLink from their beginnings to the end of October 2023. The inclusion criteria were systematic reviews, clinical guidelines, retrospective studies, and case reports on chlorfenapyr poisoning that focused on its mechanisms, clinical presentations, and treatment strategies. The references in the included studies were also examined to identify additional sources. RESULTS:We included 57 studies in this review. Chlorfenapyr can be degraded into tralopyril, which is more toxic and reduces energy production by inhibiting the conversion of adenosine diphosphate to adenosine triphosphate. High fever and altered mental status are characteristic clinical presentations of chlorfenapyr poisoning. Once it occurs, respiratory failure occurs immediately, ultimately leading to cardiac arrest and death. Chlorfenapyr poisoning is diffi cult to treat, and there is no specifi c antidote.CONCLUSION: Chlorfenapyr is a new pyrrole pesticide. Although it has been identified as a moderately toxic pesticide by the World Health Organization (WHO), the mortality rate of poisoned patients is extremely high. There is no specifi c antidote for chlorfenapyr poisoning. Therefore, based on the literature review, future eff orts to explore rapid and eff ective detoxifi cation methods, reconstitute intracellular oxidative phosphorylation couplings, identify early biomarkers of chlorfenapyr poisoning, and block the conversion of chlorfenapyr to tralopyril may be helpful for emergency physicians in the diagnosis and treatment of this disease.

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Deep Brain Stimulation Withdrawal Syndrome, a Rare Life-Threatening Condition in Neurology and Neurosurgery

Bril,

Tomskiy,

Gamaleya

et al. 2024

Annals of Clinical and Experimental Neurology

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The article addresses an acute condition associated with an abrupt cessation of neurostimulation of deep brain structures, which is manifested by acute hypokinesia and rigidity with further development of akinesia, anarthria and dysphagia. This may result in the need for emergency hospitalization and admission to an intensive care unit. The article presents literature review and clinical case reports. We discuss causes and approaches to the prevention and management of acute decompensation in patients with Parkinson's disease associated with abrupt deep brain stimulation cessation.

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Parkinsonism-Hyperpyrexia Syndrome: A Case Series and Literature Review

Cited by 3 publications

References 31 publications

Parkinsonism-Hyperpyrexia Syndrome in a patient undergoing upper gastrointestinal surgery: A case report

Parkinsonism-Hyperpyrexia Syndrome in a patient undergoing upper gastrointestinal surgery: A case report

Chlorfenapyr poisoning: mechanisms, clinical presentations, and treatment strategies

Deep Brain Stimulation Withdrawal Syndrome, a Rare Life-Threatening Condition in Neurology and Neurosurgery

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