Acute and Critical Care

Neurology
Malignant Syndrome in Parkinson Disease Similar to Severe Infection: Dong Hun Lee, Jeong Mi Moon, Yong Soo Cho; Korean J Crit Care Med. 2017;32(4):359-362. Published online December 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00087

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A 70-year-old woman with Parkinson disease was admitted to the emergency department with altered consciousness, fever and convulsive movements without experiencing withdrawal from antiparkinsonian medication. Six hours after the emergency department visit, the patient had a hyperpyrexia (>40°C) and a systolic blood pressure of 40 mmHg. There was no evidence of bacterial infection based on extensive workups. The patient was discharged without aggravation of Parkinson disease symptoms after treatment that included administration of dantrolene sodium, enforcement of continuous renal replacement therapy and cooling blankets. Malignant syndrome should be suspected if high fever occurs in Parkinson disease patients without evidence of a definitive infection.

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Parkinsonism-Hyperpyrexia Syndrome and Dyskinesia-Hyperpyrexia Syndrome in Parkinson’s Disease: Two Cases and Literature Review
Jian-Yong Wang, Jie-Fan Huang, Shi-Guo Zhu, Shi-Shi Huang, Rong-Pei Liu, Bei-Lei Hu, Jian-Hong Zhu, Xiong Zhang
Journal of Parkinson's Disease.2022; 12(6): 1727. CrossRef

Neurology
Clozapine Induced Neuroleptic Malignant Syndrome: Yong Suk Jo, Hyung Ah Jo, Byung Chul Yu, Jung Hoon Shin, Kook-Hwan Oh; Korean J Crit Care Med. 2017;32(3):291-294. Published online December 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00052

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Abstract PDF

Neuroleptic malignant syndrome is a rare, but potentially life-threatening adverse event associated with the use of neuroleptic agents. We describe the case of a 47-year-old schizophrenic woman who was treated with clozapine for years. The patient developed acute renal failure with pulmonary edema, and underwent mechanical ventilation and hemodialysis.

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Toxicity and Adverse Effects in Clozapine-Related Presentations to a Medical Toxicology Service in Western Sydney
Pramod Chandru, Naren Gunja
Journal of Medical Toxicology.2023; 19(4): 374. CrossRef

Neurology
Malignant Neuroleptic Syndrome following Deep Brain Stimulation Surgery of Globus Pallidus Pars Internus in Cerebral Palsy: Jae Meen Lee, Sun Ha Paek, Hye Ran Park, Kang Hee Lee, Chae Won Shin, Hye Young Park, Hee Pyoung Park, Dong Gyu Kim, Beom Seok Jeon; Korean J Crit Care Med. 2016;31(1):34-38. Published online February 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.1.34

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Neuroleptic malignant syndrome (NMS) is a rare but potentially lethal outcome caused by sudden discontinuation or dose reduction of dopaminergic agents. We report an extremely rare case of NMS after deep brain stimulation (DBS) surgery in a cerebral palsy (CP) patient without the withdrawal of dopaminergic agents. A 19-year-old girl with CP was admitted for DBS due to medically refractory dystonia and rigidity. Dopaminergic agents were not stopped preoperatively. DBS was performed uneventfully under monitored anesthesia. Dopaminergic medication was continued during the postoperative period. She manifested spasticity and muscle rigidity, and was high fever resistant to anti-pyretic drugs at 2 h postoperative. At postoperative 20 h, she suffered cardiac arrest and expired, despite vigorous cardiopulmonary resuscitation. NMS should be considered for hyperthermia and severe spasticity in CP patients after DBS surgery, irrespective of continued dopaminergic medication.

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Metal-free carboxyl modified g-C3N4 for enhancing photocatalytic degradation activity of organic pollutants through peroxymonosulfate activation in wastewater under solar radiation
Xueting Mei, Shujun Chen, Gangqiang Wang, Wenxing Chen, Wangyang Lu, Bingying Zhang, Yu Fang, Chenxiao Qi
Journal of Solid State Chemistry.2022; 310: 123053. CrossRef

Malignant Cerebral Infarction after Pulmonary Resection for Lung Cancer: In Ae Song, Sang Min Jung, Dong Jin Kim, Sang Heon Park; Korean J Crit Care Med. 2013;28(3):180-183.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.180

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Abstract PDF: Malignant cerebral infarction as postoperative complication after pulmonary resection occurs rarely, but can be rather serious. We report a case of 81-year-old man who suffered from malignant cerebral infarctions after pulmonary resection for lung cancer. He had a history of well-controlled hypertensions, but no evidences of arrhythmia, and neither stenosis nor atheroma in the carotid arteries and intracranial arteries. There were no specific events during his operation except that an inadvertent left carotid artery puncture occurred during the central line insertion. In intensive care unit (ICU), he had a delayed recovery of consciousness and dysarthria with right hemiplegia. Computed tomography revealed malignant middle cerebral infarctions due to the occlusion of left middle cerebral artery. It could be the thromboembolism due to pulmonary resections or carotid artery punctures in the patient without high risk factors.

A Case of Successful Natural Stenting in Tracheobronchial Restenosis with Malignant Tumor after Metallic Stenting: Goohyeon Hong, Kyeongman Jeon, Sang Won Um, Won Jung Koh, Gee Young Suh, Man Pyo Chung, O Jung Kwon, Hojoong Kim; Korean J Crit Care Med. 2012;27(2):111-114.; DOI: https://doi.org/10.4266/kjccm.2012.27.2.111

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Abstract PDF: Tracheal tumors are very rare disease, which may cause dyspnea, obstructive pneumonia and life-threatening hypoxemia, depending on the site of the lesion and the severity of the narrowing. Such patients frequently die within hours or days due to suffocation. Patients who expressed upper airway stenosis, should be secured the airways prior to the diagnosis and treatment commonly. Then, treatment plan should be determined. For the relief of such stenosis, various modalities of therapy including surgery, laser photoresection, balloon dilatation and sometimes stent insertion have been used. Tracheobronchial stent insertion has been a good therapeutic option in these patients in point of avoiding morbidities associated with surgery. We report a case of repeated tracheobronchial stenosis by infiltrating tumor mass after metallic stent insertion in a 48-year-old man. The patient was treated successfully by Natural stent insertion with rigid bronchoscopy after removal of previous inserted metallic stent.

Delayed Onset of Malignant Hyperthermia: A Case Report: Jeong Wook Lim, Seok Kon Yeo, Seong Hwan Yang, In Seok Hwang, Jong Soo Lee; Korean J Crit Care Med. 2009;24(3):168-171.; DOI: https://doi.org/10.4266/kjccm.2009.24.3.168

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Abstract PDF: Malignant hyperthermia is a potentially fatal genetic and metabolic myopathy that presents with high fever, and muscle rigidity, and it often occurs after administering anesthetic medication. Most cases of malignant hyperthermia occur during anesthesia or surgery, but delayed malignant hyperthermia is very rare, and if it is detected late, it has a high mortality rate. A 39-year-old male with an acute subdural hematoma underwent decompressive craniectomy without any intraoperative medical problems, but a high fever above 40degrees C occurred after 8 hours and he was dead in spite of aggressive management after 48 hours postoperatively. We present here a case of delayed malignant hyperthermia along with a review of the related literature.

Dantrolene and Post-operative Hyperthermia: A Case Report: Ja Kyung Koo, Cheol Hong Kim, Ah Leum Lim, Se Ah Kwon, Ji Young Park, Soon Jae Lee, In Gyu Hyun, Je Hyun Yoo; Korean J Crit Care Med. 2009;24(2):92-98.; DOI: https://doi.org/10.4266/kjccm.2009.24.2.92

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Abstract PDF: Malignant hyperthermia is a rare, fatal pharmacogenetic disorder that occurs during general anesthesia following exposure to a depolarizing muscle relaxant, such as succinylcholine, or volatile anesthetics. Clinical findings in malignant hyperthermia include muscle rigidity, sinus tachycardia, increased CO2 production, skin cyanosis with mottling, and marked hyperthermia. For treatment, cooling techniques must be accompanied by discontinuation of the provocative medication. Furthermore, dantrolene administration is the mainstay of treatment for malignant hyperthermia, and should be initiated as soon as the diagnosis is suspected. We recently experienced a case with post-operative fever of 41.0degrees C refractory to conventional anti-pyretic measures and finally resolved with dantrolene administration, in a patient with methicillin-sensitive Staphylococcus aureus monoarthritis of the knee and rapid progression of diffuse septic pneumonia requiring mechanical ventilation.

Malignant Hyperthermia during General Anesthesia: Two cases: Eun Chung Cho, Eun Sung Kim, Young Ho Hong, Yeon Jang, Soo Seok Park; Korean J Crit Care Med. 1997;12(1):89-94.

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Abstract PDF: Malignant hyperthermia is a hypermetabolic disorder of skelectal muscle. It goes fatal progress in the majority of cases unless early diagnosis and treatment are performed. We experienced two cases of malignant hyperthermia during general anesthesia. First case is 7-year-old boy with congenital bilateral ptosis. Second case is 46-year-old male with lung cancer. We were faced to difficult intubation due to masseter muscle spasm. After induction, tachycardia, muscle rigidity, body temperature elevation, end tidal CO2 elevation and acidosis developed. Enflurane was discontinued, vigorous emergency treatment was attempted. Fortunately, two patients were recovered from malignant hyperthermia and then discharged without complications.

Malignant Hyperthermia Syndrome: A case report: Ji Yeon Kim, Eun Jung Kwon, Mi Kyoung Lee, Sang Ho Lim, Suk Min Yoon, Young Seok Choi; Korean J Crit Care Med. 1997;12(1):85-88.

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Abstract PDF: Malignant hyperthermia (MH) is an inherited skeletal muscle disorder characterized by hypermetabolism, muscle rigidity, rhabdomyolysis, fever, metabolic acidosis and death if untreated. The syndrome is believed to result from abnormal control of intracellular calcium ions in the skeletal muscle: on exposure to certain anesthetics, calcium level is increased, and then it activates contractile processes and biochemical events that support muscle contraction. We experienced a MH of 2 years-old male who had release of sternocleidomastoid muscle due to torticolis under general anesthesia. Anesthesia was induced with thiopental and succinylcholine, maintained with enflurane, nitrous oxide and oxygen (2 volume%: 2 L/min: 2 L/min). After induction of anesthesia, his heart rate, end-tidal CO2 tension and body temperature had been gradually increased and then those were reached to maximal value of heart rate (160~170 BPM), end-tidal CO2 tension (60~70 mmHg) and body temperature (41degrees C) 55 minutes later. He was immediately managed with symptomatic treatment such as hyperventilation with oxygen, cooling, beta-blocker, sodium bicarbonate and diuretics, so he was survived without any sequelae.

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