Sindrom diskinezija-hiperpireksija – novo hitno stanje kod Parkinsonove bolesti: prikaz slučaja

Abstract

Sažetak. Cilj:Sindrom diskinezija-hiperpireksija hitno je stanje u Parkinsonovoj bolesti do kojeg dolazi zbog pretjerane dopaminergičke stimulacije. Kolebanje koncentracije dopamina uzrokuje generalizirane atetotske diskinezije s izrazitom hipertermijom, rabdomiolizom te konfuznim stanjem. Cilj rada jest prikazati slučaj pacijenta koji boluje od Parkinsonove bolesti, a prezentirao se diskinezijama i hiperpireksijom. Prikaz slučaja: Prikazujemo slučaj pacijenta u dobi od 55 godina koji je zatražio pomoć zbog visokog febriliteta i pogoršanja diskinezija u trajanju od 15 dana. Pacijent je, usprkos detaljnom kliničkom pregledu i laboratorijskoj obradi, bio neprepoznat. U daljnjem tijeku liječenja stanje pacijenta se pogoršalo u vidu izrazite hiperpireksije uz razvoj respiratorne insuficijencije i cirkulacijske nestabilnosti. Nakon četiri tjedna liječenja u jedinici intenzivnog liječenja pacijent je s teškom autonomnom disfunkcijom završio smrtnim ishodom. Zaključak: Ovaj slučaj upućuje na važnost ranog prepoznavanja diskinezija i hiperpireksije kao hitnog stanja u pacijenata oboljelih od Parkinsonove bolesti s ciljem rane medikamentne potpore te sprječavanja po život opasnih posljedica.Abstract. Aim: Dyskinesia-hyperpyrexia syndrome is a rare case of medical emergency in Parkinson's disease caused by excessive dopaminergic stimulation. It is characterized with severe continuous dyskinesias associated with rhabdomyolysis, hyperthermia, and subsequent alteration of the mental state. The aim of this paper is to present a clinical case of a patient with Parkinson's disease presenting with dyskinesia and hyperpyrexia. Case report: We present a case of a 55-year-old patient who presented with high body temperature and worsening of dyskinesia that lasted for 15 days. The patient, despite a detailed clinical examination and laboratory examination, was unidentified as such. In the further course of the treatment, the condition of the patient deteriorated in the sense of extreme hyperpyrexia with the development of respiratory insufficiency and circulatory instability. After four weeks of treatment in the Intensive Care Unit, the patient passed away with severe autonomic dysfunction. Conclusion: This case emphasizes the importance of early recognition of dyskinesia and hyperpyrexia as an emergency in Parkinson's disease with the aim of early medical support and prevention of life-threatening consequences.

Emergencies in movement disorders

“…Dyskinesia-hyperpyrexia syndrome (DHS) is a rare neurological emergency induced by increased dopaminergic activation in patients with PD (12). DHS has many similarities with PHS and SS, but it is primarily characterized with massive hyperkinesia.…”